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HX64075630 
R  A776  B24  How  to  preserve 


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LORENZ    REICH, 

Direct  Importer  of  the  Choicest  and  Purest 
EVER  BROUGHT  TO  THIS  COUNTRY. 

STRICTLY  FOR  MEDICINAL  USE. 
334    FIFTH    AVENUE,    COR.    33d    STREET, 

(HOTEL    CAMBRIDGE). 


Mr.  Retch  will  be  pleased  to  see  all  those  who  desire  to  avail  them- 
selves of  the  opportunity  of  procuring  strictly  first-class  Wines,  which 
have  received  the  indorsement  of  the  most  eminent  medical  men  of  the 
country,  as  is  evidenced  from  the  following  letters  of  commendation  which 
have  been  received  : — 

This  is  to  certify  that  I  have  examined  Mr.  L.  REICH'S  TOKAYER  AUSBRUCH, 
TOKAYER  MASLAS  and  BUDAI  IMP.  I  take  great  pleasure  in  commending 
these  Wines  to  the  medical  profession,  because  of  their  purity. 

R.  OGDEN  DOREMUS,  M.  D.,  LL.D. 

We  have  used  in  our  practice  the  Hungarian  Wines  sold  by  Mr.  Lorenz 
Reich,  who  puts  them  on  the  market  unadulterated,  just  as  they  are 
imported.  To  this  fact  we  attribute  their  great  value  as  a  medicine  in 
diseases  where  such  tonics  are  indicated,  especially  in  those  which  are 
attended  by  defective  digestion  and  imperfect  assimilation.  We  cordially 
recommend  Mr.  Reich  and  his  Wines  to  our  professional  brethren. 
J.  Marion  Sims,  M.  D.,  LL.D.  I     Prof.  D.  Hayes  Agnew,  M.  D.,  LL.D. 


Prof.  J.  Lewis  Smith,  M.  D. 

Prof,  Lewis  A.  Sayre,  M.  D. 

Prof.  P.  F.  Munde,  M.  D. 

Prof.  Stephen  Smith,  M.  D. 

Prof.  Alh-ed  L.  Loomis,  M.  D.,  LL.D. 

Prof.  J.  W.  Wright,  M.  D. 

Prof.  Isaac  E.  Taylor,  M.  D. 

Prof.  S.  D.  Gross,  M.  D.,  LL.D.,  Oxon. 


Prof.  William  A.  Hammond,  M.D. 

Prof.  Roberts  Bartholow,  M.  D,  LL.D. 

Prof.  Fordyce  Barker,  M.  D.,  LL.D. 

Nathan  Bozeman,  M.  D. 

Luis  F.  Sass,  M.  D. 

Prof.    William  H.   Thomson,  M.  D., 

LL.D. 
Prof.  WUlard  Parker,  M.  D.,  LL.D. 


And  lOO  more  Eminent  Physicians. 
The  Wines  will  be  shipped  to  any  part  of  the  United  States. 

LORENZ  REICH,  334  FIFTH  AYE.,  COR.  33d  ST., 

Bran«h  Office:  70  State  Street,  Chicago,  III. 

(i) 


BOVININE. 

Beef  juices,  or  raw  meat  extracts,  are  very  valuable  on  account  of  their 
immense  nutrient  force  in  a  concentrated  form,  the  small  quantity  required, 
its  tolerance  by  the  stomach,  and  rapid  and  complete  assimilation,  whereby 
the  strength  and  vital  powers  are  quickly  nourished  and  maintained. 
Many  «« meat  extracts"  and  "  raw  food  extracts"  are  upon  the  market, 
containing  no  food  or  nutritive  properties;  for  instance,  the  "beef  tea," 
actually  containing  no  food  virtue  whatever,  being  merely  a  temporary 
stimulant,  upon  which  a  patient  would  soon  starve.  "  Bovinine,"  however, 
is  very  rich  in  all  the  elements  entering  into  the  formation  of  blood  and 
tissue,  is  easily  borne  by  the  most  delicate  stomach,  0/  excellent  taste  and 
odor,  \nd  is  rapidly  and  completely  assimilated.  The  meats  used  are 
from'  the  best  parts  of  finest  beef.  Its  great  nutrient  qualities,  and  its 
large  percentage  of  Albuminoids  make  "Bovmine  "  superior  to  any  other 
raw  food.     In  general,  the  following  formulae  will  be  found  useful : 

In  cases  of  extreme  weakness  caused  by  wasting  diseases,  where  the 
patient's  digestive  powers  are  greatly  enfeebled,  begm  with  one  teaspoon- 
ful  of  "Bovinine"  once  in  three  hours,  diluted  with  three  times  the 
quantity  of  milk,  or,  if  this  does  not  readily  assimilate,  cold  water  or  gruel 
may  be  substituted,  adding  a  little  salt.  The  dose  should  be  gradually 
increased  to  a  tablespoonful  four  times  per  day  at  intervals  of  four  hours. 

If  the  patient  is  suffering  from  anaemia,  nervous  prostration,  neuralgia, 
inanition,  or  any  of  the  numerous  forms  of  chronic  gastric  disturbance, 
accompanied  by  loss  of  appetite,  insomnia,  mental  depression,  etc.,  with- 
out being  confined  to  bed,  a  dessertspoonful  of  "Bovinine"  may  be  ad- 
ministered, extended  with  twice  or  thrice  the  quantity  of  milk,  Tokay 
wine,  or  other  palatable  fluid,  adding  salt  to  taste,  as  in  No.  i,  and 
increasing  to  the  maximum  dose  of  four  tablespoonfuls  daily,  taken  before 

meal  and  on  retiring. 

I^OES.^viE'CrXj.^    OiTo.    3. 

Infants  from  one  week  to  two  years  old  that  are  puny  and  feeble,  and  do 
not  thrive  upon  their  diet,  can  be  restored  to  health  and  their  rapid 
growth  promoted  by  the  judicious  use  of  "Bovinine."  From  five  to  thirty 
drops  added  to  its  milk  three  times  daily  will  cause  a  visible  and  rapid 
improvement,  and  the  treatment,  if  continued,  will  give  such  strength  and 
vigor  to  the  infant  as  to  enable  it  to  pass  through  the  vicissitudes  of  child- 
hood with  impunity. 

Attention  is  called  to  "Bovinine"  as  especially  adapted  to  parturient 
women,  as  it  supplies  new  and  vitalized  blood  with  great  rapidity. 

CAJREFTJjLTjT  rHEFAItEn   BY 

The  J.  P-  Bush  MTg  Companyp 

2  BARCLAY  STREET,  NEW  YORK  CITY, 


"THE   ORIGINAL 

Elixir  of  Calisaya," 

Introduced  by  J.  Milhau  in  1830, 

Has  maintained  for  sixty  years  the  highest  repu- 
tation as  a  pleasant,  reliable,  wholesome  bitter 
tonic.  It  creates  appetite,  relieves  exhaustion, 
tones  up  the  system,  and  is  a  preventive  of  Ma-^ 
laria.  Invaluable  to  all,  including  women  and 
children.  

A  Prominent  Physician  writes: 

"Milhau's  Elixir  of  Calisaya  is  one  of  the  best  preparations  as  a 
tonic  I  have  ever  used.  Patients  who  are  run  down  and  debilitated  are 
invariably  benefited  by  its  administration.  I  prescribe  it  quite  frequently, 
and  find  good  results  in  every  instance." 


J.    MILHAU'S    SON, 

^  pbarmaceutical  Cbemtst, 
183  BROADWAY,    NEW   YORK. 

ESTABLISHED  Br  J.  MILHAU  IN  1813. 

SPECIALTIES : 

The  importation  of  New  Remedies  and  the  dispensing 

of  Physici^-ns'  Prescriptions. 

(iii) 


MOTHERS, 

What  Do  You  Feed  The  Baty? 

LACTO-PREPARATA, 

A  PREPARED  HUMAN  MILK, 

Is  a  pure  Milk  Food  designed  more  especially  for  Infants 
under  6  months  of  age. 

It  is  the  nearest  approach  to  mother's  milk  that  can  be  produced 
and  be  permanent.  It  is  prepared  from  cows'  milk  and  contains  no  cereal 
carbohydrates,  and  being  partially  peptonized,  will  digest  as  readily  and 
nourish  the  child  as  perfectly  as  human  milk. 


CARNRICK'S  SOLUBLE    FOOD 

Is  composed  of  cows'  milk,  partially  predigested,  to  which  has  been 
added  a  sufficient  proportion  of  wheat,  (the  starch  of  which  has  been 
converted  into  dextrine  and  soluble  starch)  and  milk-sugar,  to  make  the 
total  percentage  of  carbohydrates  equal  to  that  of  human  mUk. 

We  claim  for  both  these  foods: 

1.  That  they  are  superior  to  any  other  prepared  foods. 

2.  That  they  are  perfect  foods  in  themselves,  requiring  no  addition  of 
cows'  milk  (as  do  all  other  foods  offered  for  sale),  thus  avoiding  the  danger 
from  the  use  of  cows'  milk,  especially  in  large  cities. 

3.  That  the  casein  is  partially  digested,  so  as  to  be  as  readily  assimilated 
as  human  milk. 

4.  That  the  milk  in  these  preparations  has  been  sterilized,  and  that  ttey 
are  prepared  with  scientific  skill  in  every  detail.  They  have  been  pre- 
pared and  improved  by  the  advice  and  aid  of  the  best  physicians  and 
chemists  in  this  country  and  Europe,  among  whom  are  Prof.  J.  Lewis 
Smith,  New  York ;  Prof.  Attfield,  London  ;  Prof.  V.  C.  Vaughan,  Ann 
Arbor,  Mich.;  Prof.  Stutzer,  Bonn,  Germany, 


OTTR  BAST* 8  JFIBST  JLNI>  8JEC02fI>  YBAItS,  a  booJc  of  48  pages, 
by  Mcirion  Sarlcmdf  sent  free  &y 

REED  &  CARNRICK, 

NEW   YORK. 

(ir) 


HOW  TO  PRESERVE  HEALTH. 


BY 

LOUIS    BARK  AN,   M.  D. 


ALL  RIGHTS  RESERVED. 


THE  TRADE  SUPPLIED  BY  THE  AMERICAN  NEWS  COMPANY, 

NEW  YORK. 

1890. 


OPINIONS   OF   DISTINGUISHED 
PHYSICIANS. 


FORDYCE  Barker,  M.  D.,  Professor  Bellevue  Medical  College,  N.  V. 

*  *  *  I  regard  your  book,  ' '  How  to  Preserve  Health, ' '  as  the 
most  sound,  sensible,  and  useful  book  on  the  topics  which  it  discusses 
that  I  have  met  with,  I  wish  it  could  be  in  the  hands  of  every  intelligent 
head  of  a  family  and  in  the  library  of  every  school,  for  I  think  it  would 
popularize  a  vast  amount  of  important  and  useful  knowledge,  and  thus  be 
of  great  service  to  the  community.  I  am  particularly  pleased  with  one 
feature  of  it  :  that  it  does  not  profess  to  teach  dosing  and  drugging,  which 
our  anxious  grandmothers  and  others  lacking  the  requisite  elementary 
knowledge  are  too  prone  to  indulge  in,  and  oftentimes  do  great  harm 
thereby.     I  congratulate  you  on  the  wisdom  and  success  of  this  effort. 

Paul  Mund^,  M.  D.,   Professor  of  Gyncecology,  New   York  Polyclinic. 

*  *  *  Your  plan  of  imparting  useful  knowledge  about  the  preser- 
vation of  health  to  the  laity,  from  a  medical  standpoint,  strikes  me  as  de- 
cidedly novel  and  exceedingly  practical,  and  I  predict  for  your  book  a 
popularity  which  I  think  it  heartily  deserves.  It  is  excellent  reading,  and 
brings  before  the  people  many  topics  of  every-day  life  which  are  not 
usually  touched  upon  in  popiJar  works,  and  which  everyone  ought  to 
know  something  about.  I  congratulate  you  on  the  successful  accomplish- 
ment of  your  task. 

W.  Oliver  Moore,  M.  D.,  Prof,  of  Diseases  of  the  Eye  and  Ear,  N,  F, 

*  *  *  I  am  sure  that  all  who  read  your  book  are  to  be  helped,  and 
find  something  of  interest  and  profit. 

T.    Mitchell  Prudden,   M.  D.,    Professor  College  of  Physicians  and 

Surgeons,  New   York. 

*  *  *  I  have  found  your  book  extremely  interesting,  and  admire 
the  skill  with  which  you  have  brought  together  such  a  wealth  of  impor- 
tant facts.  It  seems  to  me  that  you  have  steered  most  wisely  among 
the  many  shoals  of  popular  instruction  in  hygiene.  The  book  will,  I  am 
sure,  do  much  good. 

D.  B.  St.  John  Roosa,  M.D.,  Prof,  of  Diseases  of  the  Eye  and  Ear,  N.  Y, 

I  take  my  first  opportunity  to  thank  you  for  your  book,  and  to  assure 
you  that  I  have  read  it  with  pleasure  and  profit. 

Louis  A.  Sayre,  M.  D.,  Professor  Bellevue  Medical  College,  N.  Y, 

I  have  read  your  book  with  great  pleasure  and  profit.  If  the 
instructions  therein  given  could  be  universally  disseminated  and  followed, 
it  would  be  of  inestimable  value  to  the  community. 

V) 


Andrew  H.  Smith,  M.  D.,  Professor  Bellevue  Medical  College^  N.  K 

*  *  *  I-  think  your  book  well  fitted  to  convey  to  the  general  public 
information  of  the  utmost  importance  to  them,  and  I  trust  that  it  will  have 
a  wide  circulation. 

Samuel  Sherwell,  M.  D.,  Prof,  of  Diseases  of  the  Skin,  Brooklyn. 

*  *  *  Your  excellent  treatise,  entitled  "  How  to  Preserve  Health," 
appears  to  me  admirably  adapted  for  the  reading  of  the  laity,  correcting 
as  it  does  a  large  number  of  false  impressions  that  prevail  among  them. 
The  direct  suggestions,  as  in  remarks  on  the  Skin,  are  of  decided  value. 

Alexander   T.    C.    Skene,    M.  D.,   Frof  of  Gyncecology,  Brooklyn. 

*  *  *  I  have  read  your  book  with  great  interest  and  profit.  You 
have  rendered  the  people  and  the  medical  profession  a  great  service.  I 
feel  confident  that  your  book  will  meet  with  the  success  it  certainly  deserves. 

George  Reuling,  M.  D.,  Professor  of  Diseases  of  the  Eye,  Baltimore. 

*  *     *     Your  valuable  book  fills  a  decided  chasm  in  our  literature. 
William  H.  Welch,  Professor  Johns  Hopkins  University, 

Your  work  seems  to  me  to  contain  much  valuable  and  correct  in- 
struction, and  I  regard  it  as  superior  to  most  similar  popular  works. 

NiC.  Senn,  M.  D.,  Prof,  of  Surgery,  Rush  Med.  College,  Chicago. 

I  thank  you  for  your  kindness  in  sending  me  a  copy  of  your  most 
valuable  and  interesting  book.  It  is  the  best  book  on  the  subject  I  have 
seen,  and  reflects  great  credit  on  you  as  a  writer  on  popiilar  medicine. 


OPINIONS   OF  THE  PRESS. 


The  New   York  Sun,  March  8,  1890 : 

An  excellent  popular  treatise,  which  in  no  way  intrudes  upon  the 
province  of  the  legitimate  practitioner  of  medicine,  is  Dr.  Barkan's  "  How 
to  Preserve  Health."  It  is  replete  with  common  sense  notions,  clearly 
and  forcibly  expressed,  and  may  fitly  supplement  the  functions  of  the  family 
physician,  who  would  doubtless  cordially  recommend  it  to  his  patients. 

The  New   York  Press,  March  9,  1890  : 

The  writer  of  the  useful  hand-book,  "How  to  Preserve  Health,"  gives 
in  a  straightforward  and  untechnical  style  much  valuable  advice  on  the 
simple  laws  of  health.  *  *  *  This  work  is  suited  to  the  popular  needs, 
being  printed  in  large  and  clear  type  and  sold  at  a  low  price,  while  con- 
taining  in  brief  and  pithy  sentences  a  fund  of  valuable  advice  and  infor- 
mation. Dr.  Barkan's  views  may  conflict  here  and  there  with  certain 
venerable  theories  and  practices,  but  they  are  undoubtedly  based  on 
scientific  truth  and  common  sense. 

(vi) 


The  New  York  Herald^  April  20,  1890  : 

*'  How  to  Preserve  Health  "  is  a  simple,  sensible  handbook  of  health; 
*  *  *  Many  books  of  similar  purpose  are  already  in  the  market;  this 
new  one  seems  as  good  as  any  and  much  better  than  some  of  them." 

The  NrM  York  Journal  of  Commerce,  March  3,  1890: 
"How  to  Preserve  Health"  is  the  title  of  a  plain,  practical  work  by 
Dr.  Louis  Barkan.  It  is  a  very  simple  treatise  on  the  laws  of  health,  and 
is  far  better  adapted  to  family  reading  than  a  mere  scientific  work.  Its 
rules  for  the  care  of  health  and  the  treatment  of  disease  are  free  from 
technicalities  and  easily  understood.  It  is  adapted  to  all  ages  and  condi- 
tions and  a  valuable  addition  to  the  library. 

The  Mail  and  Express,  New  York,  April  3,  1890 : 

*  *  *  The  dififerent  chapters  take  a  wide  range  of  subjects  bearing 
on  the  ends  in  view,  and  Dr.  Barkan's  suggestions  upon  all  of  them  are 
eminently  judicious  and  valuable.  The  book,  which  has  been  commended 
by  the  highest  medical  authorities,  is  an  excellent  one  for  the  household. 

HalPs  Jotirtial  of  Health,  New  York,  April,  1890  : 

"  How  to  Preserve  Health"  is  a  manual  of  hygiene  for  both  sexes, 
which  extends  from  infancy  to  old  age,  and  treats  of  almost  every  ailment 
that  flesh  is  heir  to  in  a  plain,  straightforward  manner,  without  the  use  of 
technical  words  and  obscure  phrases,  hence  it  is  admirably  adapted  for  a 
family  guide.  The  subjects  are  well  arranged,  and  if  the  advice  given 
for  preventing  the  inroads  of  disease  are  followed,  there  will  be  littie  need 
of  calling  in  the  family  doctor. 

The  Sanitarian,  New  York,  April,  1890 : 

"How  to  Preserve  Health"  is  an  excellent  summary  of  the  most 
healthful  conditions,  devoid  of  all  technicahties,  and  eminently  practical 
in  the  use  of  imiversally  available  means  promotive  of  health  and  lon- 
gevity. 

The  Observer,  New  York,  April  24,  1890 : 

The  subjects  treated  are  many,  but  the  advice  given  on  all  is  wise  and 
helpful.  Dr.  Louis  Barkan  has  displayed  a  great  deal  of  skill  in  his 
arrangement  of  the  book,  and  it  will  be  an  invaluable  help  in  the  house^ 
hold  where  it  is  used. 

The  Golden  Rule,  Boston,  April  to,  1890 ; 

*'  How  to  Preserve  Health  "  is  a  sensible,  plain,  nnexceptionally  wise 
manual  to  instruct  readers  what  to  do  that  they  may  preserve  and  enjoy 
health  and  avoid  sickness.  *  *  *  With  the  purpose,  style,  and  con- 
tents of  this  book  we  are  pleased.  It  seems  safe  and  trustworthy,  and 
carries  the  promise  of  much  usefulness. 

The  Examiner,  New  York,  March  13,   1890: 

"How  to  Preserve  Health,"  by  Dr.  Barkan,  commends  itself  as  a 
sensible  and  simple  treatise  that  does  not  by  any  means  attempt  to  make 
every  man  his  own  doctor,  but  rather  shows  him  how  he  may  measurably 
avoid  the  necessity  for  "doctoring  "  altogether.    Most  of  the  ills  that  flesh 

(vii) 


is  said  to  be  heir  to  are  preventible,  and  books  like  this  tell  how  to  prevent 
them.  If  men  and  women  would  read  such  a  book  before  the  mischief  is 
done,  and  profit  by  what  they  read,  the  race  would  be  healthier. 

The  School  Journal,  New  York,  March,  1890: 

"How  to  Preserve  Health"  seems  a  good  book  to  have  at  hand. 
Most  persons  neglect  their  health  in  one  way  or  another,  but  most  per- 
sons, as  Carlyle  said,  are  fools.  This  book  is  meant  to  remove  one  kind 
of  foolishness. 

The  Turf,  Field  and  Farm,  New  York,  March  28,  1890 : 

"  How  to  Preserve  Health  "  is  the  title  of  a  plain,  common-sense-like 
book.  Whoever  complies  with  the  hygienic  and  dietetic  rules  laid  down 
with  clearness  will  enjoy  better  health,  and  life,  it  stands  to  reason,  will 
be  prolonged. 

Other  favorable  reviews  have  been  published  by  the  Christian  Advo' 
cate,  the  Christian  at  Work^  the  Church  Union,  Munsey's  Weekly,  etc. 

(viii)  ^ 


PREFACE. 


The  author  of  this  work  has  labored  with  the 
object  of  giving  to  the  pubhc  an  available  handbook 
of  hygiene  and  sick-room  assistance,  founded  upon 
the  most  recent  developments  in  medical  knowledge. 
Through  this  medium  it  is  designed  to  bring  the 
reader  into  closer  accord  with  the  aims  and  methods 
of  the  physician. 

To  preserve  health  of  body  and  integrity  of  mind 
both  in  the  individual  and  in  communities  is  an 
object  worthy  of  the  supreme  endeavor  of  every 
human  being,  for  upon  these  depends  our  own  pros- 
perity and  that  of  our  offspring.  A  task  so  impor- 
tant may  be  thought  to  represent  the  focus  of  our 
endeavor,  about  which  all  other  effort  radiates  to  a 
circumference  of  true  happiness  and  prosperity. 

He  whose  taste  runs  to  quackery  and  old  wo- 
men's gossip  will  find  little  satisfaction  in  this  book  ; 
but  he  who  is  accessible  to  the  voice  of  reason,  to 

science,  and  to  a  ripe  experience,  cannot  fail  of  be- 

3 


coming  an  apostle  to  its  teachings.  In  this  belief 
the  author  is  content  to  submit  his  production  to  the 
considerate  interest  of  the  public. 

In  conclusion,  he  would  offer  his  sincere  thanks 
to  the  authors  whose  papers,  by  permission,  he  oc- 
casionally quotes,  and  to  their  publishers,  Messrs. 
■William  Wood  in  ITew  York  and  Lea  Brothers  in 
Philadelphia. 


TABI^E   OF   CONTENTS. 


PAGE 

iKTRomKrrioN 7 

Part  First — The  Prevention  of  Disease 9 

Food 12 

Fatty  and  Albuminous  Substances  and  the  Carbo-Hydrates,  24  ; 
the  Adulteration  of  Food,  37  ;  Impediments  to  Nutrition,  41. 

Hygienb  of  Different  Organs 47 

The  Digestive  Organs,  47  ;  the  Respiratory  and  Circulatory 
Organs,  53  ;  the  Skin — Dress,  62  ;  Light,  73  ;  the  Nervous 
System,  77  ;  the  Eye,  83  ;  the  Ear,  87  ;  the  Nostrils,  88  ;  the 
Taste,  89  ;  the  Voice,  90  ;  the  Muscles,  92  ;  Variations  in 
Individual  Ability,  100. 

Hygiene  of  Age  and  Occupation 103 

Infancy,  103;  Childhood,  115;  School-children,  117;  Youth, 
121  ;  Adult  Life,  122  ;  Old  Age,  123  ;  Health  and  Morals, 
127  ;  Marriage,  131  ;  the  Workshop,  133. 

Hygiene  of  the  Dwelling 138 

Ventilation,  141  ;  Sewerage  and  Drainage,  143  ;  Disinfection, 
150  ;  Graveyards,  157;  American  and  European  Houses,  160  ; 
Climate,  164. 

Part  Second — ^The  Care  of  the  Sick 169 

Nursing 170 

Thb  Family  Physician « 184 

_  _  6 


6 

PAGB 

How  TO  Give  Aid  in  Emergencies 187 

Fainting  and  Trance,  188  ;  Drowning,  192  ;  Suffocation,  198  ; 
Sunstroke,  203;  Hemorrhage,  210;  Wounds,  213;  Burns, 
217;  Poisoning,  221. 

Contagious  and  Miasmatic  Diseases 241 

Intermittent  and  Malarial  Fevers,  246  ;  Typhoid  Fever,  248  ; 
Yellow  Fever,  25 1 . 

Diseases  of  the  Nervous  System : 253 

Hysteria,  253  ;  Epilepsy  and  St.  Vitus's  Dance,  254  ;  Insomnia, 
256. 

Diseases  of  Altered  Nutrition 259 

Anaemia 'and  Chlorosis,  259  ;  Dropsy,  260  ;  Obesity,  261  ;  Apo- 
plexy, 264;  Gout,  267;  Rheumatism,  269  ;  Tuberculosis,  271. 

Diseases  of  the  Respiratory  Tract 272 

Cough,  272;  Pulmonery  Consumption,  274;  Croup  and  Diph- 
theria, 285  ;  Asthma,  286  ;  Hay  Fever,  288. 

Diseases  of  the  Digestive   Tract 290 

Dyspepsia,  290  ;  Seasickness,  297;  Asiatic  Cholera,  305  ;  Dysen- 
tery, 308;  Summer  Complaint,  310;  Constipation,  316; 
Hemorrhoids,  321. 

Diseases  of  the  Urinary  Tract 324 

Diseases  of  the  Skin 326 

Parasites , , 328 

Motherhood.  ..,».., 33Q 


INTRODUCTION. 


As  every  man  is  in  a  measure  the  master  of  his 
own  fate,  he  is  also,  to  a  great  extent,  the  master  of 
his  health.  Wisely  and  intelligently  to  make  use  of 
his  liberty  and  individual  rights,  he  must  overcome 
many  prejudices  ;  and  this  is  equally  the  case  in  re- 
gard to  his  health.  In  order  to  understand  what  is 
really  needful  to  a  full  enjoyment  of  health,  and  in 
order  to  understand  the  great  importance  of  early 
medical  assistance  in  cases  of  necessity,  one  must 
uproot  various  old  prejudices  and  abandon  bad 
habits. 

The  author  of  this  little  volume  proposes  to  in- 
struct his  readers  what  to  do  that  they  may  preserve 
and  enjoy  health  and  avoid  sickness,  in  so  far  as 
human  foresight  can  accomplish  these  ends.  It  is 
not  intended,  however,  to  advise  them  how  to  treat 
themselves  in  case  of  sickness,  for  the  writer  be- 
lieves that,  so  soon  as  unmistakable  signs  of  dis- 
ease are  perceived,  a  physician  should  be  called. 

7 


8 

The  only  exceptions  are  cases  of  emergency,  espe- 
cially where  there  is  danger  to  life.  These  will  be 
fully  and  extensively  treated,  and  intelligent  advice 
will  be  given.  The  author  would  think  of  advising 
even  an  educated  layman  to  treat  himself  as  little  as 
he  would  of  putting  a  loaded  pistol  into  the  hands  of 
a  child. 

By  carefully  studying  this  book  and  by  comply- 
ing with  the  hygienic  and  dietetic  rules  herein  laid 
down,  the  reader  will  be  able  to  preserve  his  health 
and  prolong  his  life.  The  author  is  very  well  aware 
of  the  fact  that  the  rules  of  hygiene  are  insisted 
upon  by  every  sensible  physician;  but  he  also  knows 
very  well  how  frequently  they  are  disregarded  and 
forgotten. 

A  good  physician  recognizes  the  value  of  intelli- 
gent obedience  in  his  patients,  and  the  exact  fulfill- 
ment of  his  directions  gives  him  satisfaction  nearly 
equal  to  that  which  attends  good  pay  for  his  ser- 
vices. It  is  accordingly  the  author's  intention  to 
impress  upon  the  reader  the  necessity  of  living  up 
to  the  wishes  and  advice  of  his  physician, 


PART  FIRST. 


THE  PREVENTION  OF  DISEASE, 


It  is  easier  to  prevent  disease  than  to  cure  it.  To 
this  end  we  must,  of  course,  know  the  conditions 
necessary  for  the  possession  and  preservation  of 
health. 

The  agencies  and  influences  to  be  spoken  of  in 
this  connection  are  air,  water,  food,  light,  and  the 
other  forms  of  force  and  matter  which  determine 
the  change  of  tissue  in  the  human  system.  Beside 
these  is  the  influence  of  environment,  varied  by  indi- 
vidual circumstances,  such  as  climate,  soil,  weather, 
habitation,  occupation,  and  clothing. 

Health  as  well  as  disease  may  be  inherited  by 
children  from  their  parents.  The  importance  of  con- 
forming to  the  rules  of  hygiene  must  not,  therefore, 
be  judged  merely  from  the  individual  standpoint. 
Such  conformity  will  be  valuable  not  only  to  parents, 
but  also  to  their  offspring  for  generations,  and,  if 

9 


10 


universal,  will  enable  us,  we  may  claim,  gradually 
to  improve  the  whole  human  race. 

The  first  important  principle  by  which  he  must  be 
governed,  who  wishes  to  enjoy  a  long  and  healthful 
life,  is  that  of  securing  a  normal  and  regular  con- 
tinuance of  tissue-change  throughout  his  body.  This 
Tissue  Metamorphosis,  as  it  is  called,  consists  in 
the  constantly  proceeding  waste  of  tissue  and  its  re- 
generation. That  these  may  progress  freely,  the  fol- 
lowing rules  must  be  complied  with: — 

1.  To  furnish  a  sufl&cient  supply  of  normal, 
healthy  blood,  the  Food  taken  must  be  wholesome 
and  abundant,  and  the  air  inhaled  must  contain  the 
required  amount  of  oxygen,  while  those  constituents 
of  the  blood  which  represent  the  unavoidable  tissue 
waste  must  be  readily  and  constantly  eliminated. 

2.  The  Circulation  of  the  Blood  must  be  free 
and  rapid,  so  that  it  may  constantly  pass  through 
all  parts  of  the  body,  in  order  that  tissue  waste  may 
be  eliminated,  and  that  new  matter  may  be  dis- 
tributed to  the  tissues  in  need  of  it,  where  new  con- 
stituents are  ready  to  be  taken  up. 

3.  Activity  must  alternate  with  rest  in  order  to 
maintain  tissue  change  and  regeneration  at  the 
proper  standard,  and  an  equable  tempt^rature  is  re- 
quired for  the  same  purpose.  The  desired  Regen- 
eration of  the  Blood  is  very  frequently  interfered 
v>^ith  by  improper  food  and  eating,  and,  more  par- 


11 

ticularly  among  the  poorer  classes,  by  an  insuffi 
cient  supply  of  food.  The  same  holds  true  as  to  the 
quality  of  the  air  inspired.  The  loss  of  heat  occa- 
sioned by  bodily  labor  on  the  one  hand,  and  by  cold, 
during  winter  and  in  cold  climates  generally,  on  the 
other  hand,  must  be  made  good  by  a  larger  supply 
of  food. 


FOOD. 


Every  article  used  as  food  is  made  up  of  organic 
(vegetable  or  animal)  or  of  inorganic  (mineral)  mat- 
ter, and  should  contain  all  the  various  constituents 
of  the  human  body  in  such  form  that  they  may  be 
readily  changed  into  living  flesh,  bone,  and  other 
tissues.  The  most  digestible  food  is  that  which  can 
be  easily  acted  upon  by  our  digestive  organs,  and 
thence  absorbed  with  facility  by  the  blood.  Some 
kinds  of  food  are  very  nourishing,  but  very  hard  to 
digest;  while,  on  the  other  hand,  matter  that  is  easily 
digestible  is  not  necessarily  nourishing.  Digestibility 
is  greatly  influenced,  also,  by  the  manner  in  which 
food  is  prepared  or  partaken  of.  For  instance,  Meat 
will  be  more  easily  digested  when  it  is  well  cooked 
and  thoroughly  masticated.  So,  also,  beans,  lentils, 
and  peas  are  more  easily  digested  when  strained. 
The  more  important  articles  of  food  are  water, 
albuminous  substances  (white  of  egg,  meat,  etc.), 
fatty  substances  and  carbo-hydrates  (sugar,  starch, 
etc.),  table-salt,  and  the  salts*  of  lime,  sodium,  and 


*  Salts  are  compounds,  containing  one  or  more  of  these  substances 
combined  witb  an  acid. 

12 


13 

iron.  Animal  substances,  especially  when  taken  in 
a  soft,  pulpy  form,  are  more  easily  digestible  than 
vegetable  substances.  Spices  and  Condiments  do 
not  contribute  anything  toward  building  up  the 
tissues  of  the  human  body  :  they  only  serve  to  im- 
prove the  taste  of  the  food  and  to  promote  digestion 
by  increasing  the  flow  of  the  digestive  fluids. 

Food  is  the  more  digestible,  the  more  soluble  it  is 
in  the  Digestive  Fluids.  The  latter  comprise  the 
saliva,  the  gastric  juice,  the  bile,  the  pancreatic 
juice,  and  the  intestinal  secretions.  Therefore, 
water,  sugar,  and  the  blood  salts  will  be  the  most 
rapidly  taken  up  into  the  blood ;  albuminous  matter, 
if  finely  cut  up  and  of  soft  consistency,  will  be  more 
easily  digested  than  when  taken  in  more  solid  form  ; 
small  pieces  of  fatty  matter  more  easily  than  fat  in 
large  lumps  ;  the  flesh  of  young  animals,  or  well 
cooked  meat,  more  easily  than  tough  meat,  meat 
from  old  animals,  smoked  or  salted  meat.* 

Digestion  is  accelerated  by  an  increased  flow  of 
the  digestive  fluids.  Thus,  starchy  substances  will 
be  better  digested  when  the  flow  of  saliva  is  in- 
creased ;  albuminous  substances  when  the  gastric, 
pancreatic  and  intestinal  juices  flow  freely;  while 
the  bile,  pancreatic  and  intestinal  juices  must  in- 
crease in  quantity  for  the  rapid  digestion  of  fats. 

*  There  is  one  exception  :  veal  is  digested  mucli  more  slowly 
tlian  beef. 


14 


An  essential  point  in  this  connection  is  the  ability 
of  the  digestive  fluids  to  permeate  the  food.  Thus, 
if  food  is  surrounded  by  some  substance  imperme- 
able to  aqueous  liquids,  as,  for  instance,  fatty  matter 
or  the  skin  of  certain  vegetables,  it  is  difficult  of 
digestion.  Porous  matter  is  digested  much  more 
quickly  than  more  compact  substances.  It  is  for 
this  reason  that  bread  which  has  not  raised  well  is 
harder  to  digest  than  when  properly  raised,  hard 
cheese  is  more  difficult  of  digestion  than  soft  cheese, 
fat  and  greasy  food  than  moderately  fat  food,  and. 
food  incompletely  chewed  than  that  which  has  been 
thoroughly  masticated.  Food,  furthermore,  is  easier 
to  digest  the  more  nearly  it  resembles  in  its  compo- 
sition the  components  of  the  human  body:  therefore 
animal  is  more  easily  digestible  than  vegetable  food. 

Those  races  which  live  on  Vegetable  Diet  princi- 
pally are  not  powerful,  but  are  of  a  mild  disposition 
and  apt  to  become  enslaved,  while  races  which  pre- 
fer an  Animal  Diet  are  warlike  and  jealous  of  their 
liberty.  History  teaches  us  beyond  contravention 
that  those  nations  which  have  accomplished  most  in 
the  course  of  time  are  those  which  have  lived  upon 
a  Mixed  Diet.  Life  in  the  temperate  zone,  in  which 
the  races  most  advanced  in  civilization  dwell,  per- 
emptorily demands  a  mixed  diet ;  agriculture  and 
the  tending  of  cattle  are  both  favored  by  its  condi- 
tions.    In  hot  climates,  on  the  other  hand,  a  vef  "^ 


table  diet  is  preferable ;  while  in  the  frigid  zone  an 
animal  diet  is  the  most  suitable. 

What  to  Do  before  or  after  a  Meal  is  a  question 
of  great  importance  so  far  as  digestion  is  concerned. 
Thus,  it  is  advisable  to  shun  bodily  or  mental  exertion 
immediately  before  eating,  and  weak  and  anaemic 
persons  may  even  take  a  short  nap  with  advantage 
just  before  sitting  down  to  table. 

The  table  should  be  set  in  a  light,  airy  room, 
moderately  heated,  while  the  mental  atmosphere 
should  be  one  of  quiet  and  happy  relaxation.  ITo 
pressure  should  be  allowed,  over  the  region  of  the 
stomach  especially,  from  tight  lacing,  belts,  or  other 
constrictions.  Solid  food,  meat  particularly,  should 
be  cut  up  into  small  pieces  and  well  masticated.  It 
is  best  to  eat  slowly,  and  to  drink  now  and  then,  as 
required.  Drinking  during  meals  is  hurtful  only 
when  too  much  liquid  is  taken,  or  when  fluids  are 
drunk  along  with  fatty  substances. 

Digestion  is  promoted  by  the  use  of  condiments 
and  mild  stimulants,  such  as  tea  and  certain  kinds 
of  Wine,  in  moderate  quantities.  Clarets,  genuine 
sherry  and  genuine  port  wine  contain  the  mineral 
salts  of  the  blood  in  proper  proportions  :  they .  are 
therefore  not  only  stimulants,  but  actually  nutri- 
tious. If  taken  in  excess,  however,  they  inevitably 
prove  injurious. 

Warm  meals  are  as  a  rule  easier  to  digest  than 


u 


cold  ones,  but  extremes  must  be  avoided.  Too  hot 
or  too  cold  substances  are  always  injurious  to, the 
stomach,  alternation  between  the  two  espec^'ally  so. 

A  short  Nap  after  meals  is  strongly  to  be  advised: 
bodily  or  mental  exertion,  at  least,  should  never  be 
attempted  at  this  time.  Professor  Hyrtl  has  proved 
that  the  old  view,  according  to  which  bodily  exercise 
was  recommended  to  follow  eating,  is  erroneous. 
He  fed  two  dogs  of  equal  development  with  equal 
quantities  of  the  same  kind  of  food,  and  found,  upon 
making  autopsies,  that  the  dog  which  had  remained 
quietly  at  home  had  digested  his  meal  much  better 
than  the  one  which  had  been  on  a  lively  run  for 
several  hours  succeeding  the  meal. 

This  after-dinner  nap  is  especially  to  be  recom- 
mended to  persons  who  have  been  very  active  up  to 
meal  time,  and  also  to  those  suffering  from  anaemia 
or  nervousness.  It  should  not  last  longer,  however, 
than  from  half  an  hour  to  an  hour  :  sleeping  too 
long  will  retard  digestion.  For  the  latter  reason  it 
is  not  advisable  for  those  who  live  a  sedentary  life 
to  partake  of  a  full  meal  shortly  before  retiring  for 
the  night.  Sleeping  too  long  with  a  full  stomach, 
aside  from  the  above  considerations,  frequently 
proves  disagreeable  by  causing  bad  dreams  and  a 
feeling  of  oppression. 

The  Number  of  Meals  and  the  Selection  of  Foods 
must  be  determined  with  a  view  to  such  consid- 


17 


^rations  as  the  age,  the  sex,  and  the  constitution 
of  the  individual,  the  state  of  his  health,  his  mode 
of  life,  the  climate  in  which  he  lives,  the  season  of 
the  year,  and  the  time  of  the  day.  It  must  not  be 
assumed  that  a  single  article  of  food,  not  even  milk, 
will  suffice  for  every  constitution,  every  age,  and 
every  occupation ;  this  is  not  to  be  thought  of.  The 
kind  of  food  must  change  with  the  systemic  condi- 
tion of  the  individual. 

In  general,  experience  and  habit  will  enable  us 
to  determine  what  kinds  of  food  and  drink  will  best 
agree  with  us.  During  the  period  of  growth,  a  pro- 
cess dependent  upon  the  new  formation  of  tissues  in 
excess  of  the  tissue  waste  which  is  constantly  going 
on,  the  child  needs  a  very  nutritious,  but  mild,  non- 
stimulating  diet.  At  this  age,  meat  and  fats  are  es- 
pecially suitable.  In  adult  life,  when  there  is  an 
equilibrium  established  between  waste  and  supply, 
the  diet  must  be  regulated  accordingly.  In  ad- 
vanced life,  when  waste  is  in  excess,  a  light  diet  of 
easily  digestible  and  slightly  stimulating  food  is  in- 
dicated. 

The  Cost  of  Food  is  not  always  in  proportion  to 
its  nutritive  value.  The  earlier  fruits  and  vege- 
tables of  the  season  do  not  possess  great  nutritive 
value  in  spite  of  their  high  price.  On  the  contrary, 
they  exert  a  harmful  influence  upon  nutrition,  es- 
pecially in  the  case  of  persons  with  poor  digestion. 


18 


since  they  exclude  more  desirable  food  from  the 
stomach.  On  the  other  hand  there  are  many  articles 
of  diet  of  great  nutritive  value  which  are  compara- 
tively cheap,  such  as  eggs  (in  summer  especially), 
milk,  leguminous  vegetables  (dried  peas,  beans,  and 
lentils),  certain  kinds  of  fish,  and  certain  portions  of 
animal  food  (the  kidney,  the  liver,  the  marrow,  the 
sweetbread). 

In  some  countries,  as  in  America,  fishes'  heads  are 
given  or  thrown  away,  while  elsewhere  they  are  con- 
sidered a  delicacy.  In  the  same  way  fish  roes,  which 
are  very  nutritious,  are  mostly  neglected,  while  in 
Austria  they  are  utilized  in  the  preparation  of  an 
agreeable  bitter  soup.  In  Austria,  southern  Ger- 
many, France,  and  Switzerland  good  prices  are  paid 
for  the  spleen,  the  brain,  the  lungs,  and  the  udder  of 
the  cow,  while  in  the  northern  countries  of  Europe 
these  portions  of  the  animal  are  not  partaken  of, 
even  among  the  poor.  Leguminous  vegetables  are 
used  as  an  article  of  food  very  generally  throughout 
Europe,  while  in  our  country  they  form  a  less  fre- 
quent article  of  fare — a  fact  not  at  all  to  our  advan- 
tage. Jews  and  Mohammedans  are  very  fond  of 
calf's  and  sheep's  pluck  a/ad  of  tripe,  viands  of  which 
Christian  peoples  make  little  use. 

Still  wider  Divergencies  exist  in  the  matter  of 
Taste,  as  we  may  see  from  the  following  list  of  ex- 
traordinary nutriments : 


19 


The  Patagonians  in  South  America  and  the 
Kirghis  and  other  races  in  Central  Asia  prefer  horse 
flesh  to  any  other.  That  which  thej  enjoy  tastes, 
of  course,  much  better,  and  is  far  more  tender  than 
that  to  which  the  poor  in  European  cities  are  accus- 
tomed, inasmuch  as  they  choose  younger  animals 
for  slaughter.  It  may  not  come  amiss  to  remark 
here  that  in  time  of  war,  when  provisions  are  fre- 
quently to  be  obtained  only  with  the  greatest  diffi- 
culty, the  flesh  of  horses  killed  in  action  might  be 
advantageously  utilized  as  food  for  the  soldiers. 

Italians,  it  is  said,  hold  cat  meat  in  high  esteem  ; 
and  many  persons,  not  improbably,  are  accustomed 
to  partake  of  our  feline  pet  under  the  guise  of 
roasted  hare,  more  especially  in  such  larger  cities 
of  the  Continent  as  Paris  and  Vienna. 

The  Chinese  are  given  to  fattening  dogs  for  their 
table ;  they  dote  on  shark's  fins  and  rat  stew.  In 
some  tropical  and  sub-tropical  countries  monkeys, 
lizards  and  snakes  are  considered  delicacies,  even  by 
Europeans  living  there ;  and  among  the  civilized 
nations  of  Europe  and  America  there  are  some 
gourmands  who  like  to  see  young  crows,  frogs  and 
snails  on  their  bill  of  fare.  Soup  of  may -bugs,  old 
Gorgonzola  (cheese  swarming  with  mites),  and  even 
skunks  are  enjoyed  by  some.  The  latter,  of  course, 
must  be  killed  unawares.  The  Abyssinians  cut  a 
steak  from  the  living  ox,  whose  wound,  immediai^ly 


20 


Covered  again  by  the  skin  previously  reflected,  heak 
rapidly  in  the  pure  atmosphere  of  the  high  plateaus. 
In  Africa,  the  fair  young  belles  of  the  Gallas  tribe 
tie  a  silken  thread  about  a  cow's  neck,  puncture  one 
of  the  swollen  veins,  collect  the  blood  in  vessels,  and 
offer  it  while  still  warm  for  the  refreshment  of  their 
swains.  The  Chinese  prefer  eggs  containing  a 
partly  hatched  chicken.  Arabs  and  Indians  like 
fried  locusts.  The  Botocudes  on  the  banks  of  the 
Amazon  swallow  caterpillars,  ants  and  their  eggs, 
or  rather  chrysalises,  as  delicacies.  The  Otomakes 
of  the  Orinoco  eat  a  certain  kind  of  earth  or  clay, 
probably  impregnated  with  organic  matter.  The 
Esquimaux  cut  off  comfortable  strips  from  a  seal, 
and  with  matrimonial  tenderness  assist  its  ingestion 
by  alternately  pushing  the  pieces  down  one  an- 
other's throats,  finishing  the  meal  with  a  copious 
draught  of  whale  oil. 

In  reading  of  these  strange  preferences  we  may 
smile  or  shudder,  as  the  case  may  be ;  and  yet  it  is 
all  a  matter  of  habit  in  educating  the  taste  in  cer- 
tain directions,  which  we  are  apt  to  call  perverse, 
because  they  are  not  quite  in  accordance  with  our 
own  taste.  This  is  best  illustrated  by  the  fact  that 
some  articles  of  our  diet  are  shunned  by  other  races. 
Thus,  it  is  reported  that  the  Garrows  and  the  Nogas, 
some  semi-civilized  tribes  in  Farther  India,  and  also 
the  inhabitants  of  Cochin-China,  detest  the  milk  of 


21 


animals  as  an  article  of  food,  and  deem  it  absolutely 
impure.  The  Kafirs  avoid  fish,  the  Hindoos  fish 
and  meat ;  and  two  hundred  and  fifty  millions  of 
Mohammedans,  as  well  as  ten  millions  of  Jews  and 
at  least  forty  millions  of  other  people,  belonging  to 
various  races  and  religious  sects,  refuse  pork  or 
meat  of  every  kind. 

If  Too  Much  Food  is  ingested,  it  is  of  importance 
whether  this  happens  only  occasionally  or  whether 
it  is  done  frequently  and  repeatedly.  In  the  latter 
case  the  polyphagia,  or  over-feeding,  may  become  a 
habit.  This,  in  turn,  will  cause  derangement  of  the 
digestive  organs,  if  the  food  is  hard  to  digest.  Such 
troubles  are  principally  referable  to  the  liver,  in 
consequence  of  stagnation  of  the  blood  in  the  portal 
system.  Piles  are  also  produced  by  the  same  cause. 
Some  of  the  ill  effects  of  over-feeding  may  be  counter- 
acted, to  a  certain  extent,  by  exercise  in  the  open  air. 

The  Temperature  of  the  Food  is  of  great  im- 
portance. Although  the  effects  of  smoking  viands 
niay  be  modified  in  some  degree  by  eating  bread, 
especially  stale  dry  bread,  between  times,  it  is  best 
not  to  partake  of  very  hot  or  very  cold  substances, 
for  these  are  liable  to  cause  inflammation  of  the 
mucous  membrane  of  the  mouth,  throat,  oesophagus, 
and  stomach,  or  even  dangerous  and  lasting  contrac- 
tion of  some  portion  of  the  alimentary  tract.  The 
teeth  also  suffer  severely  from,  the  same  cause.    It  is 


22 


not  wise  to  add  irritating  substances,  such  as  strong 
spices,  in  large  quantities  to  the  food;  nor  should 
strong  liquors  be  consumed  during  the  meal,  if  at 
all,  inasmuch  as  they  injure  the  stomach  and  impair 
digestion  for  a  long  time  afterward,  and  the  habit 
of  their  use,  if  persisted  in,  leads  to  organic  disease 
of  the  stomach,  the  liver,  and  the  digestive  organs 
generally. 

Preparation  of  Food. — Aside  from  its  natural 
condition,  the  digestibility  and  the  savouriness  of 
food  is  greatly  influenced  by  the  manner  of  its  pre- 
paration. If  fruits  or  vegetables  are  to  be  eaten 
raw,  they  should  be  ripe,  verging  toward  fermenta- 
tion. If  cooked,  ripeness  is  not  essential,  because 
cooking  or  steaming,  when  thoroughly  performed, 
amounts  in  a  certain  sense  to  artificial  ripening. 
Vegetables  which  are  insufficiently  boiled  in  salted 
water,  according  to  the  English  and  American  cus- 
tom, have  hardly  any  nutritive  value.  In  order,  for 
instance,  to  render  beets  and  carrots  digestible, 
nutritious,  and  at  the  same  time  delicious,  they 
must  be  thoroughly  boiled  or  steamed  in  true  Con- 
tinental style,  that  is,  for  a  long  time,  and  with  the 
addition  of  butter  or  lard,  parsley,  or  other  condi- 
ments, or,  better  still,  together  with  a  nice  piece  of 
meat,  preferably  lamb  or  mutton.  The  same  is  true 
of  the  condition  in  which  meat  should  be  considered 
fit  for  cooking.    Kipeness  bordering  on  Ferment  a- 


23 


tion  is  obtained  by  exposing  meat  for  several  days 
to  the  air,  and  especially  to  the  crisp  air  of  vrinter. 
The  savouriness  of  game,  in  particular,  is  greatly 
enhanced  by  this  means. 

"When  the  process  of  fermentation  is  carried  too 
far  in  cereals,  light  or  heavy  spirits  result,  while  the 
checking  of  this  process  at  a  proper  time  develops 
all  the  constituents  of  the  grain  to  their  highest 
degree  of  nutritive  value,  as  we  find  in  malt  ex- 
tracts. Almost  every  country  has  its  peculiar  drinks 
as  well  as  its  peculiar  cookery.  The  South  Ameri- 
cans like  their  ^'pulque,'' the  southern  Slavs  their 
plum  spirits,  the  Russian  peasantry  a  common  soup 
called  '^  borsts,''  which  is  a  very  mild  and  agreeable 
product  of  the  fermentation  of  cabbage,  beets,  or 
bran. 

As  many  a  genial  mind  hves  in  obscurity,  so  also 
many  culinary  arts  and  specialties  thrive  for  a  long 
time  unthought  of  and  unknown  by  the  more  civil- 
ized nations.  Thus,  the  inhabitants  of  the  Balkans 
do  not  know  that  they  possess  delicious  wines,  and 
that  they  understand  how  to  cook  cabbage,  rice,  and 
beans  in  an  incomparable  manner.  On  the  other 
hand,  the  Morlaks  and  Dalmatians  of  the  mountains 
do  not  dream  that  they  commit  an  offense  against 
the  aesthetic  sensibility  of  a  refined  palate,  when 
they  bury  milk  in  a  pit  for  the  purpose  of  allowing 
it  to  become  cheese. 


24 


FATTY    SUBSTANCES     AITD     THE     CARBO- 

HYDRATES. 

Fatty  substances  and  the  carbo-hydrates  are  to  a 
certain  extent  the  heat  producers  of  the  human 
body,  while  Albuminous  Matters  may  be  said  to 
build  up  its  machinery,  the  muscular  system.  Since 
the  work  of  a  muscle  is  performed  by  the  combus- 
tion of  substances  rich  in  carbon,  a  large  amount 
of  such  substances,  in  the  form  of  fat,  sugar,  and 
the  starchy  foods,  should  be  eaten  by  those  who  do 
laborious  work.  As,  from  the  different  portions  of 
a  steam  engine  small  particles  of  iron  and  other 
metals  are  continually  rubbed  off  by  use,  and  repairs 
are  thereby  made  necessary  in  course  of  time,  so  in 
the  human  system  the  albuminous  substances  which 
compose  the  muscular  apparatus  are  gradually  con- 
sumed and  albuminous  food  must  be  eaten  to  replace 
them. 

The  fatty  substances  which  we  add  to  our  food, 
such  as  butter,  lard,  and  oil,  do  not  merely  serve  as 
nutriment,  but  play  also  an  important  part  in  the 
production  of  heat  and  muscular  power.  It  has  been 
established  by  experiment  that  starch  is  converted 
more  easily  into  sugar  when  it  is  taken  together 
with  fatty  substances  than  when  eaten  alone. 
Sugar,  syrup,  honey,  and  like  substances,  serve  not 


25 


merely  to  improve  the  taste  of  food,  but,  like  starch, 
are  utilized  as  nutriments  and  heat  producers,  being 
hydrocarbons  in  composition.  Sugar  is  much  more 
easily  digested  than  starch.  It  also  increases  the 
flow  of  the  gastric  juice,  although  it  interferes  with 
digestion,  if  large  quantities  are  consumed.  It  also 
accelerates  the  digestion  of  albuminous  substances 
and  of  those  containing  iron  and  lime,  by  its  conver- 
sion into  lactic  and  butyric  acid  while  passing 
through  the  intestinal  canal;  and  it  leaves  the  body 
at  last,  decomposed  into  water  and  carbonic  acid, 
principally  through  the  lungs. 

Iron  is  a  constituent  of  many  articles  of  diet  and 
also  of  some  beverages.  It  has  been  proven  that 
more  iron  is  ingested  in  this  form  than  the  human 
body  requires,  since  some  of  it  passes  out  of  the 
body  unused  with  the  excretions. 

Water  and  Common  Salt  are  the  two  inorganic 
substances  which  must  be  taken  in  large  quantities 
in  order  to  render  healthy  nutrition  possible.  Fully 
three-fourths  of  the  body  consists  of  water,  and  salt 
is  a  constituent  of  all  its  solid  and  liquid  compo- 
nents. But  water  and  salt  are  not  contained  in  suffi- 
cient quantity  in  the  various  animal  and  vegetable 
articles  of  food,  and  therefore  we  are  compelled  to 
salt  our  food  and  drink  water  freely. 

The  most  important  function  of  water  in  the  ani- 
mal economy  depends  upon  its  property  of  dissolving 


26 


numerous  substances.  The  water  of  springs  and 
rivers  always  contains  solid  and  gaseous  matters  of 
various  sorts,  and  our  drinking  water  sometimes 
furnishes  us  a  sufficient  quantity  of  some  of  the  in- 
organic matters.  Certain  mineral  waters,  especially 
those  containing  iron,  may  therefore  act  as  nutri- 
ments or  may  exercise  a  curative  influence. 

The  following  requirements  must  be  fulfilled  in 
order  that  a  water  may  be  both  palatable  and 
healthy :  It  should  be  clear  and  colorless  like  crys- 
tal, even  after  standing  for  some  length  of  time  ;  it 
should  show  little  beads  of  gas,  air,  and  carbonic 
acid ;  it  should  be  almost  free  from  organic  sub- 
stances and  the  products  of  their  decomposition, 
namely  ammonia  and  nitric  acid.  The  presence  of 
micro-organisms  and  of  the  products  of  decomposi- 
tion in  drinking  water  is  frequently  the  cause  of 
diseases  like  cholera  and  typhoid  fever.  Water  ob- 
tained from  wells  in  the  vicinity  of  sewers,  surface 
drains,  cesspools,  cemeteries,  and  manufactories 
should  especially  be  avoided,  as  it  is  likely  to  be 
contaminated  from  these  sources.  By  providing  a 
pure  water  supply  the  sanitary  condition  of  a  town 
or  other  connnunity  may  be  greatly  improved  and 
much  sickness  averted. 

The  simplest  means  of  purifying  water  is  by  fil- 
tering it.  For  this  purpose  the  best  substances  are 
charcoal,  or  a  conibination  of  clay  and  charcoal,  bQ- 


27 


cause  this  material  has  the  property  of  separating 
from  the  water  all  impurities,  especially  those  de- 
composed materials  which  give  it  a  bad  smell  and 
taste.  An  inexpensive  but  thoroughly  effectual  filter 
may  be  constructed  in  a  flower  pot,  by  lining  it  with 
a  layer  of  flannel,  and  then  filling  in  successively 
three  inches  of  gravel,  three  inches  of  white  sand 
washed  perfectly  clean,  and  four  inches  of  animal 
charcoal.  A  clean  sponge  may  then  be  placed 
across  the  top.  Such  methods  are  similar  to  that 
followed  by  nature,  where  the  earth  keeps  back  all 
or  most  of  the  germs  and  impurities  contained  in 
water  which  percolates  through  it. 

Formerly  it  was  believed  that  ice  could  not  pos- 
sibly contain  the  germs  of  disease.  But  Dr.  T.  Mit- 
chell Prudden  of  ITew  York  has  shown  that  ice, 
Hudson  River  ice,  for  instance,  contains  almost  all 
those  bacteria  in  an  active  state,  which  were  origin- 
ally present  in  the  water.  For  this  reason  it  is  not 
desirable  to  put  ice  in  drinking  water.  When  cold 
water  is  craved  (although  cold  water  really  inter- 
feres with  digestion),  it  should  be  boiled  and  filtered 
and  cooled  in  bottles  on  ice. 

Milk  might  well  be  called  white  blood,  since  it 
resembles  blood  so  much  in  its  composition.  It  is 
the  only  article  of  food  which,  when  taken  alone, 
will  support  life.  This  it  does  because  it  contains 
a-bout  thirty -three  per  cent,  of  blood-forming  mate- 


28 


rial,  including  all  those  elements  which  go  to  build 
up  the  human  frame. 

Human  milk  is  of  a  bluer  white  than  cow's  milk, 
and  has  a  sweeter  taste :  it  does  not  turn  sour  as 
rapidly  as  other  milk,  and  it  does  not  form  such 
thick  and  compact  curds  :  it  is  much  richer  in  milk 
sugar,  but  contains  less  caseine  (the  cheesy  material 
of  the  milk),  butter,  and  mineral  salts  than  cow's 
milk.  Ass's  milk  resembles  human  milk  very  closely. 
Goat's  milk  is  very  rich,  but  does  not  taste  well :  this 
may  be  remedied  by  mixing  cow's  milk  with  it.  Sow's 
milk  is  also  said  to  be  very  nourishing.  In  order  to 
render  cow's  milk  as  nearly  like  human  milk  as  pos- 
sible, water,  milk  sugar,  and  a  little  table  salt  should 
be  added.  Whether  it  is  true,  as  has  been  stated, 
that  the  milk  of  dark-skinned  women  is  richer  in 
caseine,  butter,  and  sugar  than  that  of  light-com- 
plexioned  individuals,  our  evidence  is  inconclusive. 
We  may  mention  in  this  connection  that  virgins,  as 
well  as  men,  have  been  known  to  nurse  infants  upon 
the  milk  of  their  own  breasts. 

It  has  been  proved  beyond  doubt  that  such  dis- 
eases as  consumption,  typhoid  and  scarlet  fevers, 
may  be  communicated  through  the  agency  of  milk. 
It  is,  therefore,  an  imperative  duty  to  boil  milk  before 
using  it,  unless  it  is  known  to  have  come  from  a 
single  healthy  cow.  The  addition  of  sodium  bicar- 
bonate, in  the  form  of  baking-soda,  or  of  mineral 


29 


water  containing  this  substance,  seems  to  render  the 
caseine  of  milk  much  more  easily  digestible :  the 
same  result  is  reached  by  skimming  the  cream  from 
the  surface  after  standing  for  some  hours.  When 
drinking  milk,  it  is  advisable  to  take  small  mouth- 
fuls  at  a  time,  and  to  eat  bread  with  it :  by  this 
means  the  curds  of  caseine,  which  are  always  pro- 
duced by  the  acidity  of  the  gastric  juice,  are  pre- 
vented from  forming  in  large  lumps  in  the  stomach. 
Milk  cannot  be  said  to  be  easily  digestible,  but  it  is 
one  of  the  most  nourishing  articles  of  food,  especially 
when  it  is  rich  in  butter  and  caseine. 

Meat. — Carnivorous  are  superior  to  herbivorous 
animals,  as  far  as  muscular  power  and  the  rapidity 
of  movement  are  concerned.  In  the  same  way,  we 
find  that  races  who  live  on  a  meat  diet  principally 
are  superior  to  those  preferring  a  vegetable  diet,  in 
muscular  energy  and  nerve  power,  as  well  as  in 
power  of  endurance. 

This  superiority  of  persons  living  on  a  meat  diet 
is  illustrated,  for  instance,  when  we  compare  an 
American  workman  with  a  Chinese  coolie,  or  English 
sailors  and  soldiers  with  those  of  India,  who  live  on 
rice  and  a  vegetable  diet  exclusively.  Working  men 
whose  diet  comprises  plenty  of  meat  are  able  to 
accomplish  a  larger  amount  of  work  in  a  given  space 
of  time  than  those  who  consume  principally  vege- 
tables.    Persons  who  have   to  do  a  great  deal  of 


30 


mental  work  know  very  well  that  a  meat  diet  is  of 
far  greater  benefit  to  them  than  a  vegetable  one. 

There  is  a  great  difference,  not  only  in  the  flesh 
of  different  species  of  animals,  but  even  in  that  of 
different  animals  of  the  same  species.  Animals 
which  do  laborious  work  during  life  furnish  hard, 
tough,  and  indigestible  meat,  the  muscular  fibres 
being  plentiful  in  proportion  as  the  fat  is  diminished 
in  quantity.  The  mode  of  killing  exercises  an  im- 
portant influence  upon  the  quality  of  meat.  The 
flesh  of  animals  which  have  been  chased  to  death, 
for  instance,  develops  a  peculiar  and  very  agreeable 
flavor,  due  principally  to  the  formation  of  lactic 
acid ;  but  it  will  not  keep,  because  of  the  presence  of 
this  acid.  On  this  account  it  is  best  to  allow  animals 
to  rest  for  twelve  or  twenty-four  hours  before  being 
slaughtered ;  the  meat  will  then  be  much  slower  in 
decomposing. 

A  very  pale  color  in  meat  is  a  sign  that  the 
animal  was  poor  in  blood  and  that  the  meat  is  want- 
ing in  nutritive  qualities :  the  cause  of  the  bloodless- 
ness  may  even  have  been  some  serious  disease.  A 
deep  reddish  purple  color  shows  that  the  animal  has 
not  been  killed,  but  that  it  died  a  natural  death.  A 
marble-like  appearance,  produced  by  layers  of  fat 
interposed  between  the  fleshy  fibres,  is  possessed  by 
none  but  good  meat.  The  fat  in  healthy  meat  is 
white  and  hard,  but  that  of  diseased  meat  is  yellow- 


31 


ish,  soft,  watery,  or  jelly-like.  Good  meat  feels 
solid  and  scarcely  moistens  the  finger,  but  diseased 
meat  is  soft  and  exudes  fluid.  Good  meat  has  no 
odor;  diseased  meat  smells  tainted.  Good  meat 
shrinks  only  slightly  in  cooking  and  loses  but  little 
in  weight ;  while  spoiled  meat  shrinks  and  becomes 
lighter,  because  in  disease  fat  and  muscle  substance 
are  consumed. 

The  mode  of  preparing  meat  for  the  table  is  of 
great  importance.  It  will  be  more  nutritious  and 
more  easily  digestible,  the  more  carefully  it  is  pre- 
pared; and,  moreover,  the  thorough  cooking  of  meat 
destroys  any  germs  or  parasites  which  it  may  con- 
tain. It  is  important  that  the  blood  should  remain 
in  the  meat.  This  end  can  best  be  fulfilled  by  ex- 
posing a  piece  of  meat  suddenly  to  a  high  tempera- 
ture, causing  the  albuminous  substances  contained 
in  the  external  layers  to  coagulate,  so  that  the  blood 
cannot  run  out.  To  do  this,  roast  the  m©at  in  a  very 
hot  oven,  at  the  same  time  pouring  over  it  frequently 
hot  fatty  gravy,  which  will  form  upon  it  a  fragrant 
brown  crust.  In  making  strong  broth  or  soup,  how- 
ever, the  best  plan  is  to  put  the  meat  on  the  fire  in 
cold  water;  the  juices  of  the  meat  will  then  mingle 
with  the  water  gradually  while  it  is  being  heated. 

Eggs  are,  next  to  milk  and  meat,  the  most  nutri- 
tious and  easily  digestible  food,  especially  when 
well  cooked  and  well  masticated.  They  contain,  like 


32 


milk,  some  portion  of  each  of  the  substances  which 
go  to  form  the  human  frame,  and  are  transformed 
into  blood  very  quickly. 

Fish  roe,  caviar,  the  eggs  of  turtles,  and  even 
those  of  alligators  are  used  as  food,  the  latter  only 
by  some  Indian  tribes  on  the  banks  of  the  Orinoco  ; 
most  frequently,  however,  the  eggs  of  birds  and 
more  especially  those  of  the  domestic  fowl  are  used. 
It  is  said  that  duck  eggs  are  still  more  nutritious 
than  the  latter,  while  a  duck  is  said  to  lay  more  eggs 
than  a  hen,  although  consuming  no  larger  amount 
of  food.  Addled  eggs  are  found  to  be  wanting  in 
transparency  when  *'  candled,"  and  are  so  light  as 
to  float  upon  a  ten  per  cent,  solution  of  common 
salt,  while  fresh  eggs,  which  contain  no  putrefactive 
gases,  will  sink. 

It  seems  to  be  established  theoretically  that  the 
white  of  a  hen's  egg  is  equally  soluble  in  the 
gastric  juice  whether  coagulated  or  only  soft  boiled. 
The  rapidity  of  its  assimilation,  however,  is  found  to 
depend  upon  the  size  of  the  pieces  of  coagulated  ma- 
terial. 

The  same  is  true  of  Cheese.  The  more  fat  it  con- 
tains  and  the  harder  it  is,  so  much  the  more  difficult 
is  it  to  digest.  Thorough  chewing  increases  its  di- 
gestibility. Old  cheese  contains  certain  fatty  acids 
which  act  similarly  to  strong  spices,  increasing  the 
flow  of  the  gastric  juice.     It  should  therefore  be 


33 


eaten  in  small  quantities  as  the  last  dish  of  a  full 
meal. 

Cheese  contains  more  albuminous  matter  than 
any  other  food.  At  the  same  time  its  chemical  con- 
stitution is  such  as  to  ensure  the  highest  degree  of 
nutritive  efficiency.  One-third  of  its  weight  is  com- 
posed of  albuminous  matter,  mostly  caseine,  while 
the  remaining  two-thirds  consists  of  butter,  milk 
sugar,  and  other  constituents  of  the  milk. 

Of  the  various  Cereals  wheat  is  the  richest  in 
vegetable  albuminoids  :  next  to  it  stands  rye  :  then 
come  rice,  sago,  tapioca,  and  arrowroot,  in  the  order 
named.  By  combining  wheat  and  rye  in  certain  pro- 
portions a  very  palatable  bread  may  be  prepared. 

Prime  Wheat  Flour  should  have  the  following 
characteristics:  When  handled  none  should  adhere 
to  the  fingers;  if  a  handful  be  squeezed,  it  should 
not  sift  through  the  fingers,  but  should  clog  together, 
forming  a  little  ball,  which  will  show  the  fine  Hues  of 
the  palm  for  some  time  after  release;  if  a  little  ball 
of  flour  be  dropped  on  a  table,  it  should  even  then 
preserve  its  form  and  continuity,  at  least  in  large 
measure.  Good  flour,  although  it  gives  distinctly 
the  sensation  of  being  composed  of  separate  parti- 
cles, is  at  the  same  time  soft  to  the  touch.  With  the 
blade  of  a  knife  it  may  be  spread  out  on  the  table  in 
a  very  thin  layer;  and,  when  stirred  up  with  water, 
the  dough  will  quickly  set  and  become  hard.    White 


34 


flour  contains  much  less  albuminous  matter  than 
those  grades  which  have  a  yellowish  tint,  the  purest 
white  flour  consisting  almost  entirely  of  starchy 
matter. 

To  keep  flour  from  spoiling,  it  should  be  thor- 
oughly dried  and  stored  in  bags,  not  in  barrels.  It 
is  said  that  the  exclusion  of  air  is  apt  to  render  flour 
somewhat  damp  and  does  not  yield  as  good  a  dough 
as  when  the  flour  remains  perfectly  dry. 

Good  Bread  will  not  have  a  sour  taste.  It  must 
be  prepared,  of  course,  only  from  good  flour.  It 
should  not  show  little  patches  of  uncooked  flour,  the 
small  cavities  due  to  gases  generated  in  the  raising 
should  be  evenly  distributed,  and  there  should  be 
no  large  cavities  nor  areas  where  none  exist.  The 
layer  directly  beneath  the  crust  should  not  be 
streaky,  and  the  crust  itself  should  not  be  black  and 
burned,  for  this  gives  a  bitter  taste :  the  crust 
should,  on  the  contrary,  be  brown,  and  its  taste 
wholesome. 

Bread  which  contains  much  albuminous  matter 
(that  is,  bran)  is  more  nutritious  ;  but  that  which  is 
light  and  which  contains  less  bran  is  more  digestible 
and  entails  but  little  labor  upon  the  digestive  appa- 
ratus. Newly  baked  bread  is  less  easily  digested 
than  bread  which  is  a  day  or  two  old,  for  the  latter 
is  more  readily  penetrated  by  the  digestive  fluids. 
Sick  people,  therefore,  and  especially  those  suffering 


35 


with  affections  of  the  stomach,  should  confine  them- 
selves to  the  use  either  of  stale  bread,  or  of  crackers, 
zwieback,  or  toast. 

Leguminous  Vegetables,  such  as  peas,  beans, 
lentils,  and  buckwheat,  are  very  nutritious  because 
of  the  amount  of  albuminoid  material  which  they 
contain,  an  amount  proportionately  larger,  in  fact, 
than  that  found  in  the  cereals,  although  their  com- 
position in  other  respects  greatly  resembles  that  of 
the  latter.  The  peculiar  vegetable  nitrogenous  prin- 
ciple which  is  said  to  contain  phosphorus  is  called 
legumine.  The  Chinese,  we  are  told,  prepare  from 
peas  a  certain  kind  of  vegetable  cheese. 

Potatoes  are  much  less  nutritious,  especially 
when  served  in  the  form  of  soup  or  mush,  although 
they  are  more  easily  digested.  In  order  to  retain 
the  nitrogenous  principle  they  should  be  thrown 
into  boiling  water  :  the  coagulation  of  the  superficial 
layers  prevents  the  escape  of  the  nutritive  elements, 
and  on  peeling  just  before  eating  the  full  benefit  is 
derived.  Potatoes  which  have  been  frozen  are  sweet, 
because  rich  in  sugar.  They  may  be  used  imme- 
diately after  they  have  been  thawed,  but  never  when 
there  is  the  slightest  sign  of  decomposition. 

Vegetables  and  fruit  in  general  do  not  possess 
marked  nutritive  value,  with  the  exception  of  cer- 
tain varieties  of  fruit  which  grow  in  tropical  and 


at) 

sub-tropical  countries,  and  which  contain  a  large 
proportion  of  sugar. 

Among  Beverages  certain  clarets  and  sweet 
wines  are  of  great  value  in  sickness,  and  still  more 
in  convalescence.  In  moderate  doses  they  are  mildly 
stimulant  and  quite  nutritious,  while  at  the  same 
time  they  admit  of  ready  assimilation.  White  wines 
and  champagne  serve  principally  as  stimulants. 
California  wines  are  very  serviceable,  and  are  not 
so  apt  to  be  adulterated  as  are  imported  wines.  For 
the  same  reason  domestic  wines  as  a  rule  are  the 
best  in  every  country. 

As  an  article  of  diet,  Beer  is  taken  for  enjoyment, 
rather  than  on  account  of  any  nutritious  qualities  it 
may  possess.  In  order  to  be  wholesome,  it  should 
be  thoroughly  fermented;  it  should  have  no  sedi- 
ment, and  should  remain  clear  and  transparent  after 
standing  for  some  time ;  it  should  not  taste  sour  or 
stale;  its  foam  should  be  white  and  milky,  with 
small  bubbles,  and  should  last  for  a  long  time. 


37 


THE  ADULTERATION  OF  FOOD. 

The  adulteration  of  food  always  lessens  its  nutri- 
tive value,  although  not  always  deleterious  to  health. 
But  in  some  instances  actual  poisons  are  introduced 
by  manufacturers  and  dealers,  whose  presence  ren- 
ders the  article,  upon  habitual  use,  gradually  de- 
structive of  life.  The  following  list  enumerates 
some  of  the  more  common  and  harmful  impurities, 
with  simple  methods  for  their  detection. 

Milk  being  a  universal  article  of  food,  its  purity 
is  of  the  utmost  importance.  It  is  chiefly  falsified 
by  dilution  with  water,  an  impurity  which  may  be 
suspected  from  the  bluish  color  and  the  scarcity  of 
fat-globules,  but  can  only  be  certified  by  the  lactom- 
eter or  by  other  scientific  tests. 

A  small  quantity  of  genuine  wheat  Flour  will  float 
upon  water,  while  the  particles  of  rice,  meal,  and 
other  substances  used  to  adulterate  it,  sink  to  the 
bottom.  After  baking,  the  presence  of  these  impuri- 
ties is  indicated  mainly  by  the  heaviness  of  the 
bread. 

Butter  may  be  very  simply  tested  for  adultera- 
tions by  spreading  a  thin  layer  upon  a  piece  of  white 
paper,  rolling  the  paper  into  a  suitable  form,  and 
setting  fire  to  it :  if  the  butter  is  pure,  an  agreeable 
odor  will  be  emitted ;  but  if  it  is  mixed  with  a^nimal 


38 

fats,  the  odor  will  resemble  that  of  burnt  tallow. 
The  presence  of  other  adulterations,  such  as  flour, 
may  be  detected  by  spreading  a  piece  of  butter  the 
size  of  a  bean  upon  a  well-folded  newspaper :  the 
butter  will  soon  soak  into  the  paper,  while  foreign 
substances  will  be  left  upon  the  surface. 

Lard  is  sometimes  adulterated  with  alum,  starch, 
and  lime-water.  When  pure,  it  is  completely  soluble 
in  benzine,  has  no  burnt  taste  or  odor,  and  melts 
without  sputtering  to  a  clear  fluid. 

Peas,  beans,  chiccory,  rye,  and  similar  kernels, 
are  the  chief  adulterations  used  in  Coffee.  They  may 
usually  be  detected  by  stirring  a  handful  of  the  sus- 
pected article  in  cold  water,  for  most  of  them  sink 
more  quickly  and  color  the  water  less  rapidly  than 
the  genuine  berry. 

It  should  be  noted,  however,  that  these  impuri- 
ties are  less  hurtful  than  coffee  itself.  ISTevertheless, 
for  the  satisfaction  of  coffee-drinkers,  and  because  it 
is  not  to  be  expected  that  any  large  number  of  these 
can  be  persuaded  to  abandon  their  favorite  beverage, 
it  is  well  to  append  certain  rules  for  the  detection  of 
coffee-grains  compounded  artificially  from  ground 
peas,  cracker-dust,  and  similar  ingredients.  Genu- 
ine coffee-grains  are  hard  and  heavy,  and  sink  quite 
readily  in  water.  Grains  which  float  upon  the  sur- 
face are  of  inferior  quahty.  Genuine  grains  do  not 
absorb  water^  but  remain  hard  and  tough.    Whether 


39 


the  grains  are  colored  or  not,  may  be  determined  by 
putting  them  into  hot  water,  and  shaking  them 
thoroughly  :  if  colored,  their  dye  will  dissolve  in  the 
water,  by  whose  aid  a  chemical  examination  of  its 
character  may  be  made.  Coffee  injured  by  sea- 
water  may  be  distinguished  from  a  disagreeable 
odor  about  the  beans  and  by  their  clinging  together. 
Furthermore,  beans  which  have  been  injured  by 
sea-water  may  be  detected  by  shaking  them  in  cold 
water  :  if  the  water  acquires  a  disagreeable  taste, 
the  coffee  has  been  in  the  sea,  and  should  be  rejected. 

Tea  leaves  are  best  distinguished  from  those  of 
other  plants  by  careful  examination  after  wetting 
and  spreading  them  out. 

Wines  are  sophisticated  chiefly  by  the  addition 
of  alcohol,  usually  in  the  form  of  poor  brandy. 
Champagne,  sherry,  and  other  high-priced  wines, 
are  not  sold  in  this  country  without  such  adultera- 
tion. Cochineal  and  fuchsine,  the  most  harmful 
coloring  matters  used,  may  be  detected  by  evaporat- 
ing a  glass  of  the  wine  to  one-tenth  of  its  quantity 
and  dipping  a  piece  of  white  wool  into  the  residue, 
when  the  dyes  indicated  will  produce  respectively  a 
permanent  red  or  pink  color.  The  coloring  matter 
of  a  pure  wine  does  not  dye  wool  without  a  mordant. 

Excess  of  fusel-oil  in  Brandy  may  be  ascertained 
by  rubbing  a  little  of  the  spirit  between  the  palms, 
a.nd  noting  whether  any  odor  reraains   after   the 


40 


alcohol  has  evaporated.  Good  brandy  evaporates 
completely,  while  the  persistence  of  an  unpleasant 
odor  indicates  impurities. 

Horse-radish  is  frequently  mingled  with  grated 
turnip,  which,  however  harmless  otherwise,  is  sure 
to  retard  digestion. 

The  Jellies  of  commerce  should  be  avoided.  They 
generally  consist  of  gelatine  and  apple  jelly,  colored 
with  poisonous  substances  and  flavored  with  un- 
wholesome essences  to  correspond  with  the  labels 
affixed. 

The  arsenic,  copper,  lead,  and  other  mineral 
poisons  often  used  in  the  manipulation  of  confec- 
tionery, sugar,  mustard,  cayenne  pepper,  pickles, 
vinegar,  tea,  beer,  and  many  other  articles  of  every- 
day consumption,  are  only  to  be  detected  by  chemi- 
cal tests. 

In  purchasing  canned  goods  it  is  a  safe  rule  to 
observe  whether  the  head  of  the  can  is  concave,  a 
bulging  appearance  beins:  indicative  of  decomposi- 
tion. 


41 


IMPEDIME]SrTS  TO  [NTUTRITION. 

When  eating  or  drinking  one  may  accidentally 
swallow  some  Foreign  Body.  If  sharp  or  pointed 
or  of  pretty  large  size,  this  may  cause  trouble  at 
some  point  in  the  digestive  tract  by  producing  in- 
flammation, obstruction,  or  actual  injury.  It  is,  for 
instance,  a  dangerous  habit  to  swallow  the  stones  of 
cherries,  plums,  and  other  fruits.  Many  cases  of 
death  from  inflammation  and  perforation  of  the 
vermiform  appendix  are  on  record,  which  owed 
their  origin  to  the  presence  of  these  foreign  bodies. 

The  young  and  eggs  of  tape  worms,  trichinae,  and 
other  Parasites  are  frequently  ingested  with  certain 
kinds  of  food,  more  particularly  with  raw  and  in- 
sufficiently cooked  meat.  These  may  remain  in  the 
human  body,  and  they  occasionally  give  rise  to  fatal 
diseases. 

The  abuse  of  Alcoholic  Liquors,  especially  the 
immoderate  drinking  of  whiskey  that  contains  much 
fusel  oil,  is  liable  to  cause  diseases,  which  will  be 
aggravated  by  bad  or  insufficient  nutrition  and  by 
lack  of  proper  clothing  and  shelter.  The  degener- 
ative processes  caused  in  many  of  the  vital  organs, 
and  particularly  in  the  liver,  by  the  abuse  of  alcohol, 
ultimately  lead  to  incurable  diseases  and  to  death. 


42 


"With  each  beat,"  says  Richardson,  "the  heart 
expels  six  ounces  of  blood.  During  sleep  ten  less 
beats  occur  in  a  minute  than  otherwise.  The  entire 
difference  in  working  power  during  a  night  of  eight 
hours,  therefore,  amounts  to  thirty  thousand  ounces 
of  blood.  If  I  lie  down  at  night  without  drinking 
alcohol,  I  obtain  the  rest  my  heart  needs ;  but  if  I 
partake  of  wine  or  spirits  before  retiring,  I  interfere 
with  that  rest,  for  the  effect  of  the  alcohol  is  to  in- 
crease the  number  of  heart-beats.  Instead  of  spar- 
ing my  heart,  I  have  added  to  its  activity  by  some 
fifteen  thousand  more  beats.  The  consequence  is,  I 
arise  wearied  and  unfit  for  the  day's  work,  until  I 
have  taken  another  dram  of  the  strong  drink  I  es- 
teem so  highly." 

It  is,  moreover,  a  fact  well  known  to  physicians 
that  hard  drinkers  have  little  power  of  resistance 
when  attacked  by  disease,  and  that  their  illnesses 
are  therefore  liable  to  assume  a  grave  character 
and  to  terminate  fatally.  Drinking  people  quickly 
succumb  to  diseases  which  under  other  conditions 
would  have  no  sinister  effect  and  which  but  rarely 
destroy  those  of  temperate  habits.  The  abuse  of  al- 
cohol even  establishes  a  predisposition  to  disease,  so 
that  hard  drinkers  are  known  to  fall  sick  much  more 
easily  than  others,  and  very  frequently  so  by  a  fault 
of  their  own.    They  make  no  effort  to  avoid  expos- 


43 


ure,  either  to  infection,  to  cold  and  wet,  or  to  other 
serious  dangers,  because  their  intellect  is  under  the 
ban  of  the  deadly  poison;  and  at  the  same  time  their 
digestive  apparatus  is  so  weakened  by  this  perni- 
cious habit  that  they  are  much  more  readily  affected 
by  cholera,  dysentery,  yellow  fever,  and  other  infec- 
tious diseases. 

The  fact  is  well  established  that  fully  one-half  of 
those  who  become  insane  bring  this  calamity  upon 
themselves,  either  wholly  or  in  part,  by  the  use  of 
alcohol.  It  is  asserted  furthermore  that  children 
begotten  in  a  state  of  drunkenness  are  epileptics 
from  their  very  birth. 

Tobacco,  whether  used  for  smoking,  chewing, 
or  snuflB.ng,  acts  first  upon  the  nerves  of  taste  and 
smell,  then  upon  the  digestive  and  respiratory 
organs,  and  finally  upon  the  general  nervous  system. 
If  a  portion  of  the  saliva  be  swallowed  while  smok- 
ing or  chewing,  catarrh  of  the  stomach  may  result, 
and  the  inhalation  of  the  smoke  may  give  rise  to  a 
similar  condition  in  the  throat  and  bronchial  tubes. 
Tobacco  should  therefore  not  be  used  by  persons 
suffering  from  affections  of  the  stomach  or  respira- 
tory organs,  especially  when  troubled  by  a  cough. 
The  salivation  occasioned  by  tobacco-smoking  is 
another  effect,  which,  by  the  constant  spitting  it  in- 
duces, more  or  less  depletes  the  blood  and  disturbs 
digestion. 


44 


Smokers  should  keep  their  mouths  and  lips  very 
clean,  as  well  as  the  pipes  and  holders  of  which  they 
make  use ;  for  it  is  a  well-known  fact  that  smokers 
are  very  apt  to  suffer  from  cancer  of  the  lips,  throat, 
and  nose.  The  habit  of  smoking  cigars  without  a 
holder  is  often  instrumental  in  the  direct  convey- 
ance of  contagion,  by  the  reason  of  the  habit  cigar- 
makers  have  of  moistening  the  cigar-cover  with 
their  lips  to  promote  adhesion. 

People  who  do  not  smoke  have  as  a  rule  a 
better  appetite  than  those  who  do,  and  possibly  the 
loss  of  appetite  so  often  complained  of  nowadays  is 
due  in  part  to  the  increase  of  this  habit.  If  smoking 
is  indulged  in  immoderately,  it  produces  consider- 
able nervous  irritation,  a  feeling  of  oppression  in 
the  chest,  palpitation  of  the  heart,  and  trembling  of 
the  hands,  and  there  may  even  appear  graver  symp- 
toms that  threaten  the  life  of  the  individual.  We 
know  of  several  eminent  surgeons  who  have  been 
obliged  to  abandon  smoking  because  their  hands 
trembled  during  operations,  the  cessation  being  fol- 
lowed in  a  few  weeks,  in  most  instances,  by  a  return 
of  manual  dexterity  and  steadiness. 

Excessive  use  of  tobacco  often  proves  injurious  to 
the  sight,  which  improves  only  when  the  habit  is 
abandoned.  Cigarettes  are  especially  harmful,  since 
the  paper  used  in  wrapping  them  is  often  impreg- 


45 


nated  with  arsenic  and  other  poisonous  substances. 
To  counteract  the  toxic  effect  of  tobacco,  vegetable 
acids  and  strong  black  coffee  may  be  administered. 

Mankind  would  be  better  off,  no  doubt,  if  the  use 
of  tobacco  were  wholly  discarded.  It  might  not 
prove  a  bad  idea  to  prescribe  smoking  in  the  schools 
as  a  degrading  punishment :  this  would  at  least  have 
a  good  effect  upon  the  boys  in  so  far  as  it  would 
tend  to  dissipate  the  foolish  notion  that  smoking 
makes  the  man.  As  has  been  tersely  said  by  a  well- 
known  author,  '^  Boys  when  smoking  imagine  they 
look  like  men,  while  men  when  smoking  really  look 
like  boys." 

Coffee,  if  strong,  or  if  taken  in  considerable 
quantities,  is  by  no  means  so  innocent  and  innocu- 
ous as  many  would  fain  believe.  It  disturbs  the 
digestion  of  some  individuals,  even  when  taken  in 
moderate  quantities  ;  and  upon  nervous  people,  or 
those  suffering  from  gout,  piles,  and  congestions  of 
the  liver  or  other  abdominal  organs  it  acts  as  a  slow 
poison.  The  use  of  coffee  should  be  controlled  by 
the  physician,  and  children  should  not  be  allowed  to 
drink  it  at  all.  The  drinking  of  strong  coffee  is 
never  advisable,  and  is  especially  unwise  after 
meals,  when  it  cannot  help  interfering  with  diges- 
tion. 

The  same  may  be  said  of  Tea.  If  partaken  of  too 


46 


frequently,  it  is  not  at  all  harmless,  but  may  cause 
alarming  nervous  symptoms. 

Cocoa  is  much  more  healthful  as  a  drink  than 
either  coffee  or  tea,  and  when  prepared  with  diluted 
milk  it  is  very  easily  digested  and  is  of  considerable 
nutritive  value.  In  Spanish  -  speaking  countries 
cocoa  is  the  national  beverage. 


HYGIENE  OF  DIFFERENT  ORGANS. 


HYGIENE  OF  THE  DIGESTIVE  ORGANS. 

The  cavity  of  the  Mouth  should  be  cleaned  fre- 
quently and  thoroughly,  in  order  that  taste  and  di- 
gestion may  not  be  interfered  with  by  accretions 
upon  its  membrane.  It  should  be  protected  besides 
from  injury  by  bones,  by  too  hot  food,  and  by  other 
harmful  agencies,  for  these  might  cause  inflamma- 
tion and  ulceration  of  the  mucous  membrane,  and 
chewing  as  well  as  swallowing  would  then  be  inter- 
fered with. 

The  Teeth  are  frequently  attacked  by  disease. 
Hollow  teeth  and  the  bad  odor  caused  by  them  could 
easily  be  avoided  by  proper  cleansing  of  the  mouth. 
The  teeth  should  be  protected  from  vegetable  para- 
sites as  weU  as  from  the  accumulation  of  tartar; 
these  should  be  removed  as  quickly  as  possible,  or 
their  bad  effects  counteracted.  After  each  meal  the 
teeth  should  be  brushed  with  alcohol  or  cologne,  to 
prevent  the  particles  of  food  remaining  in  the  mouth 
from  decomposing,  for  these  decomposing  remains 

47 


48 


of  food  form  a  hot-bed  for  the  growth  of  parasites, 
which,  however,  the  alcohol  will  destroy.  After 
this  some  innocuous  powder,  such  as  chalk,  egg- 
shells, bicarbonate  of  soda,  or  other  alkali,  may  be 
used  with  the  brush,  in  order  to  prevent  the  forma- 
tion in  the  mouth  of  acids  which  will  attack  the 
teeth. 

The  use  of  charcoal  in  cleaning  the  teeth  is  less 
agreeable,  and  should  be  advised  with  hesitation; 
while  ashes  must  be  used  under  no  consideration,  in 
spite  of  their  property  of  rendering  the  teeth  white, 
for  they  destroy  the  enamel,  and  so  facilitate  decay. 
Healthy  teeth,  like  healthy  fat  in  man,  are  not  per- 
fectly white,  but  have  a  yellowish  tint.  Those  who 
find  it  impossible  to  clean  their  teeth  during  the  day, 
should  at  least  not  neglect  to  clean  them  after  the 
last  meal,  for  the  long  interval  from  then  until 
morning  gives  abundant  opportunity  for  the  deposit 
and  putrefaction  of  foreign  substances. 

The  diligent  and  systematic  brushing  of  the  teeth 
with  a  brush  which  is  not  too  stiff  is  conducive  to 
the  health  and  beautiful  color  of  the  gums.  Gums 
which  have  not  been  brushed  for  a  long  time  lapse 
into  a  condition  of  morbid  swelling,  irritability  and 
sensitiveness  :  when  the  use  of  the  brush  is  resumed, 
therefore,  they  will  become  covered  with  blood,  a 
condition,  however,  which  will  disappear  after  the 
brushing  has  been  repeated  a  few  times.    The  un- 


49 


brushed  and  neglected  gums  resemble  the  so-called 
"proud  flesh,"  which  bleeds  with  equal  readiness, 
and  which  also  needs  to  be  hardened  and  cauterized. 

An  additional  cause  of  dental  caries  is  found  in 
inflammation  of  the  gums,  whether  due  to  pressure 
or  to  exposure  to  cold;  and  still  another  in  the 
excessive  use  of  candies  and  other  sweets,  which 
generate  lactic  acid — and  every  acid  is  injurious 
unless  the  mouth  be  sufficiently  cleansed. 

The  Throat  and  mouth  ought  to  be  kept  clean 
for  another  important  reason.  It  is  this,  that  various 
and  numerous  germs  of  disease  constantly  enter 
here,  and  either  remain  or  pass  beyond.  These 
should  be  gotten  rid  of  by  garghng  the  throat,  espe- 
cially in  the  morning,  with  some  disinfectant  solu- 
tion prescribed  by  the  family  physician.  This  is  to 
be  done  in  the  usual  manner  by  throwing  the  head 
backward  and  driving  air  through  the  water  audibly. 

Besides  these  germs  of  disease,  there  may  also 
adhere  to  the  throat  shells,  hulls,  fish-scales,  crumbs 
of  dry  pastry,  powdered  pepper  (which  causes  far 
more  irritation  than  whole  pepper),  and  other  par- 
ticles capable  of  giving  much  annoyance.  The 
irritation  produced  in  the  throat  and  air  passages 
by  mustard,  mixed  pickles,  vinegar,  spirits,  and  by 
strongly  seasoned  food,  may  be  ameliorated  by  add- 
ing to  them  milk,  eggs,  and  honey,  as  is  customary 
in  Austria  and  Poland.     Sweet  foods  and  certain 


50 

sour  ones,  which  are  liable  to  injure  the  teeth,  may- 
be neutralized  in  a  similar  manner,  the  remaining 
particles  being  carried  away  by  succeeding  mild 
food  and  drinks.  The  proper  preparation  and  suc- 
cession of  food  and  drink  is  of  great  importance,  as 
all  substances  which  irritate  the  throat  also  injure  it 
and  bring  it  into  a  favorable  condition  for  the  inva- 
sion and  adhesion  of  the  germs  of  disease. 

A  farther  source  of  injury  to  the  mouth  lies  in  the 
excessive  use  of  tobacco,  especially  when  accom- 
panied by  frequent  expectoration.  The  fact  should 
not  be  overlooked  that  the  saHva  is  a  very  important 
digestive  fluid,  that  it  is  formed  from  the  blood,  and 
that  a  waste  of  saliva  amounts  to  a  positive  loss  of 

blood. 

A  good  way  to  remove  the  various  particles  of 
food  remaining  in  the  mouth  and  throat  is  to  take  a 
few  crackers,  or,  still  better,  some  stale  bread,  after 
every  meal,  and  chew  them  very  thoroughly.  This 
will  carry  away  all  remaining  particles,  especially 
from  the  throat,  where  they  may  otherwise  irritate 
the  larynx.  The  use  of  bread  at  least  three  or  four 
days  old  is  the  best  means  of  cleansing  and  disin- 
fecting these  parts,  and  stale  bread  has  even  been 
found  by  Professor  Esmarch  to  be  the  best  disin- 
fectant for  cleaning  the  walls  of  his  hospital  rooms. 
After  swallowing  the  bread,  the  rinsing  of  the  mouth 
and  throat  should  be  proceeded  with. 


51 


It  is  a  curious  fact  that  many  people,  who  are 
scrupulously  clean  as  far  as  their  skin  is  concerned, 
are  quite  indifferent  in  regard  to  the  cleanliness  of 
their  mouths,  although  the  cleansing  of  the  mucous 
membrane  of  the  mouth  is,  in  a  certain  sense,  the 
more  important  of  the  two. 

Every  mother  should  see  that  her  children  keep 
their  mouths  clean,  and  should  teach  them  to  rinse 
and  gargle  both  morning  and  evening,  as  well  as 
after  each  meal.  In  treating  affections  of  the  throat, 
gargling  with  certain  solutions  plays  an  important 
part,  and  children  should  be  taught  how  to  gargle 
while  in  health,  and  at  as  early  an  age  as  possible, 
because  it  is  very  difficult  to  teach  them  after  they 
have  fallen  sick.  Mothers  should  also  know  how  to 
inspect  the  mouth  and  throat,  and,  if  need  be,  they 
should  be  taught  by  the  family  physician  to  do  so. 
It  is  always  better,  especially  if  diphtheria  is  about, 
to  call  a  physician  in  time,  and  this  is  made  possible 
when  the  throat  is  inspected  every  morning. 

One  more  warning  we  must  not  omit.  Never 
allow  your  child  to  be  kissed  on  the  mouth,  if  indeed 
at  all.  Teach  him  to  turn  and  hold  up  his  cheek  in 
response  to  a  visitor's  advance. 

In  order  to  keep  the  Stomach  in  a  healthy  condi- 
tion, avoid  filling  it  unreasonably  and  frequently 
with  great  quantities  of  food  or  drink.  Heavy,  in- 
digestible food  should  be  shunned,  while,  on  the 


52 


other  hand,  it  will  not  do  to  be  too  timid  in  regard 
to  the  heartiness  of  a  meal.  Treat  your  stomach  as 
you  would  any  other  organ :  it  should  be  made  hardy 
and  strong,  without  being  overworked ;  but  it  should 
by  no  means  be  allowed  to  become  weak  and  peevish 
from  having  its  tasks  made  too  easy.  Too  much 
work  weakens  not  only  the  external  muscles,  but  the 
muscles  of  the  heart  and  stomach  as  well.  A  reason- 
able amount  of  work,  however,  insures  good  diges- 
tion and  a  hardy  stomach. 

The  size  of  the  stomach  varies  in  different  indi- 
viduals, and  the  amount  of  food  habitually  taken 
varies  considerably  in  different  races.  The  colder 
the  climate  in  which  a  people  lives,  the  larger  will 
be  the  quantity  of  food  required.  Friedrich  von 
Hellwald  reports  that  among  the  Samoyedes,  the 
Laplanders,  and  the  Esquimaux  it  is  not  a  rare 
occurrence  to  see  a  man  eat  sixteen  pounds  of  meat 
and  as  many  pounds  of  fat  and  blubber  at  a  single 
meal.  Captain  Cochrane  states  that  he  has  seen 
three  Yakutis^  devour  a  reindeer  at  a  meal ;  and  a 
calf  weighing  about  two  hundred  pounds  is  not  too 
much  for  a  meal  of  five  of  these  gluttons. 

The  liquid  and  liquified  matter  in  the  intestines 
enters  the  blood  by  way  of  the  capillaries  tributary 
to  the  Portal  Vein.  This  vessel  carries  it  to  the 
liver,  after  modification  in  whose  structure  it  passes 
through  the  lower  vena  cava  into  the  right  side  of 


53 


the  heart.  In  order  to  promote  quick  incorporation 
of  digestive  material  in  the  systemic  circulation  the 
flow  of  blood  in  the  portal  vein  should  be  as  rapid  as 
possible,  an  end  to  be  attained  by  preserving  a 
healthy  liver,  by  full  inspirations  and  by  certain 
movements  of  the  abdominal  muscles,  while  it  may 
be  farther  promoted  by  careful  regulation  of  the 
bowels  and  by  drinking  water  freely  during  diges- 
tion in  order  to  dilute  the  thick  blood  of  the  portal 
vein.  Decomposition  of  the  contents  of  the  intes- 
tines is  prevented  by  the  presence  of  the  bile,  which 
at  the  same  time  dilutes  the  digested  masses  and 
neutralizes  the  excess  of  acids  formed  in  them. 


HYGIENE     OF     THE     RESPIRATORY     AND 
CIRCULATORY    ORGANS. 

Respiration  is  indispensable  to  the  himian  organ- 
ism, since  it  provides  the  oxygen  without  which  we 
could  not  live.  Health  is  in  danger  as  soon  as  we 
begin  to  breathe  an  impure  air,  or  as  soon  as  the 
function  of  the  respiratory  organs  is  in  any  way  dis- 
turbed. We  should,  therefore,  take  care  to  breathe 
fresh  and  pure  air  only,  and  to  protect  our  lungs  and 


54 

chests  from  becoming  disordered  in  any  way.  The 
first  requirement  towards  accomplishing  this  end  is 
a  sufficient  supply  of  oxygen. 

The  atmosphere  of  a  hall  where  many  people 
have  been  congregated  for  a  length  of  time  is 
rendered  impure  by  their  exhalations,  so  that  breath- 
ing becomes  difficult  and  oppressive  and  health  may 
be  actually  impaired.  The  injurious  effect  is  due 
not  merely  to  the  carbonic  acid  gas  which  every 
person  exhales  and  which  accumulates  in  such 
rooms,  but  also,  according  to  recent  investigations, 
to  a  certain  gas,  probably  nitrogenous,  which  has 
not  yet  been  definitely  ascertained.  The  deleterious 
condition  of  the  atmosphere  in  such  rooms  is  farther 
aggravated  by  gas-lights,  by  perspiration  and  other 
exhalations  from  the  skin,  and  by  various  forms  of 
excrementitious  matter.  If  the  heating  apparatus 
is  not  in  proper  working  order,  certain  gases  of  com- 
bustion are  liable  to  escape  unperceived  and  still 
farther  to  vitiate  the  atmosphere. 

An  adult  requires  a  little  more  than  one  gallon  of 
pure  air  every  minute  :  a  single  gas-jet  consumes  as 
much  oxygen  as  twelve  persons  would  require,  a 
common  iron  stove  double  this  amount.  Ventilation 
is  the  best  and  in  fact  the  only  means  of  obtaining 
pure  air.  Opening  doors  and  windows,  therefore,  can 
alone  change  the  vitiated  air  of  the  interior  for  pure 
fresh  air  from  the  outer  atmosphere.     All  rooms 


55 


where  a  large  number  of  people  assemble  should 
have  arrangements  for  easy  and  thorough  ventila- 
tion. Schools,  manufactories,  shops,  large  meeting- 
rooms,  and  halls  should  never  be  over-crowded,  and 
their  atmosphere  should  be  completely  renewed 
every  day.  Simple  fumigation  is  of  no  value  for 
this  purpose  :  ventilation  can  be  effected  only  by  a 
complete  change  of  air. 

The  room  which  demands  most  careful  attention 
in  this  respect  is  the  sleeping  apartment.  Bedrooms 
should  be  light,  sunny,  and  spacious,  and  there 
should  be  constant  change  of  air,  a  window,  either 
in  the  bedroom  itself  or  in  an  adjoining  room,  being 
partly  opened  at  night.  Babies'  clothing  should  not 
be  hung  up  to  dry  in  a  bedroom,  nor  should  soiled 
clothes  be  kept  there.  Plants  and  flowers  in  large 
numbers  should  not  stand  in  the  bedroom,  as  they 
exhale  carbonic  acid  gas  during  the  night :  in  draw- 
ing-rooms, parlors,  and  sitting-rooms,  on  the  con- 
trary, plants  with  large  leaves  are  beneficial,  because 
in  the  light  of  the  sun  they  exhale  oxygen  and  ab- 
sorb carbonic  acid  gas. 

The  most  dangerous  gases  mixed  with  atmos- 
pheric air  are  Carbonic  Acid  and  Carbonic  Oxide. 
One-half  of  one  per  cent,  of  the  latter,  if  contained 
in  the  inspired  air,  will  prove  fatal,  after  a  limited 
time,  to  men  and  animals.  It  is  the  fatal  constituent 
of  illuminating  gas.      Other  dangerous  gases  are 


56 


Marsh  Cas  and  Sewer  Gas,  the  latter  especially- 
proving  fatal  at  times  to  those  whose  work  lies  in 
or  about  sewers.  These  gases,  by  entering  an 
apartment  slowly  and  imperceptibly,  as  they  usually 
do,  endanger  health  and  life.  Probably  their  effect 
is  due  in  part  to  their  affinity  for  oxygen,  which 
causes  a  reduction  of  the  oxygen  of  the  blood  cor- 
puscles, weakening  the  whole  system  and  predispos- 
ing it  to  infection. 

Air  containing  much  Dust  is  unhealthy.  Especi- 
ally does  it  affect  young  and  growing  persons  and 
those  who  have  weak  lungs.  For  those  who  are 
forced  from  some  cause  to  remain  for  any  length  of 
time  in  a  room  filled  with  dust  particles  the  best 
protection  is  a  respirator. 

Smoke  in  the  air,  tobacco-smoke  in  particular, 
is  deleterious  to  the  respiratory  organs.  Persons 
who  are  apt  to  become  hoarse,  or  who  are  disposed 
to  cough,  should  take  pains  to  avoid  rooms  filled 
with  smoke.  Life  in  the  open  air,  particularly  in 
the  woods,  is  an  effective  means  to  the  preservation 
of  health  and  a  powerful  restorative  in  chronic  dis- 
eases. The  favorable  influence  of  traveling  and  of 
life  at  sanitariums  and  health  resorts  in  many  in- 
stances seems  chiefly  due  to  the  amount  of  time 
spent  in  the  open  air. 

Living  in  narrow  and  dark  rooms,  where  the 
breathing  space  is  small  and  fresh  air  is  deficient. 


57 


proves  very  injurious  to  health,  especially  when 
many  persons  are  crowded  into  one  room.  By  such 
a  manner  of  living  the  constitution  is  sure  to  be 
undermined  sooner  or  later,  and  the  individual  to 
become  a  prey  to  incurable  disease.  The  remedy  in 
such  cases  consists,  not  in  medicine,  but  in  fresh  air, 
exercise,  and  nutritious  food.  Children  suffer  most 
from  want  of  fresh  air,  whether  in  school  or  at 
home. 

Those  who  follow  sedentary  occupations  should 
seek  the  open  air  as  often  as  possible,  but  should  be 
careful  about  exposure  to  heat,  cold,  wet,  and  dust. 
The  effect  of  breathing  fresh  air  is  intensified  by 
methodical  exercise.  Simple  lung  gymnastics  con- 
sist in  a  number  of  full  respirations.  To  ventilate 
the  lungs,  so  to  speak,  in  this  mannner,  the  best 
time  is  from  two  to  three  hours  after  a  full  meal, 
because  then  the  exhalation  of  carbonic  acid  gas  is 
at  its  height. 

Since  sound  lungs  are  only  to  be  expected  in  a 
normally  developed  chest,  the  latter  should  be  pro- 
tected from  the  various  influences  which  tend  to 
decrease  its  capacity.  Sometimes  a  deformity  is  in- 
augurated during  the  first  hours  of  life  by  the  bad 
habit  some  nurses,  have  of  bandaging  an  infant  with 
unreasonable  tightness,  a  custom  as  earnestly  to  be 
deprecated  as  that  of  tight  lacing  in  later  years.    All 


58 


other  constrictions  by  strings  or  belts  are  quite  as 
much  to  be  avoided. 

One  word  here  about  the  Corset.  We  do  not 
wish  to  be  considered  its  irreconcilable  enemy  :  it  is 
its  abuse  only  which  must  be  condemned.  A  corset 
with  very  soft,  elastic  stays  is  not  only  comfortable 
to  the  wearer  by  supporting  the  bust  and  giving 
strength  and  stamina  to  the  whole  body,  but  it  has 
also  the  effect  of  improving  the  figure  and  rendering 
it  agreeable  to  the  beholder.  A  tightly  laced  waist, 
however,  is  exceedingly  unhealthy  and  far  from 
beautiful. 

The  practice  of  Gymnastics,  or  Calisthenics,  as 
they  are  more  commonly  called  among  us,  not  only 
tends  to  expand  the  chest  and  lungs,  but  serves  also 
to  strengthen  the  heart,  causing  its  muscular  ele- 
ments to  become  strongly  developed  and  its  contrac- 
tions more  forcible  and  regular.  It  must  always  be 
understood,  however,  that  exercise,  as  t/sU  as  work, 
should  not  be  indulged  in  to  excess.  Only  moderate, 
well-regulated  exercise  in  pure  air,  or  bodily  work 
executed  under  similar  conditions,  is  capable  of 
strengthening  the  heart  and  lungs,  and,  by  improv- 
ing the  circulation,  the  tissues  of  the  whole  body. 
An  important  consideration  in  this  respect  is  the 
maintenance  of  a  proper  balance  between  exertion 
and  rest.    If  muscular  effort  is  continued  too  long, 


59 


the  effect  on  the  muscles  is  the  same  as  that  of  pro- 
longed rest ;  they  are  weakened  and  finally  become 
unfit  for  any  exertion. 

The  renewal  of  tissue  cells  takes  place  for  the 
most  part  during  rest,  while  the  excretion  of  waste 
matters  is  promoted  considerably  by  the  activity  of 
the  various  organs.  For  this  reason  rest  is  indis- 
pensable after  exertion,  but  the  want  of  an  equable 
balance  between  the  two  conditions  is  sure  to  result 
in  impaired  muscular  efficiency.  The  fatigue  caused 
by  work  is  due  to  an  ultimate  accumulation  of  waste 
material  in  the  tissues,  and  to  the  disappearance, 
more  especially  from  the  muscles,  of  the  oxygen 
necessary  to  support  the  tissue  changes  incident  to 
exertion.  We  therefore  require  sleep,  not  only  to 
get  rid  of  waste  products,  but,  what  is  more  impor- 
tant, to  accumulate  oxygen  in  the  tissues  in  antici- 
pation of  another  day's  waste. 

Blood  is  the  direct  source  of  tissue  life.  The  ma- 
terial which  composes  the  human  frame  is  held  in 
solution  in  this  peculiar  red  fluid,  and  is  constantly 
furnished  to  each  tissue  as  it  is  required  to  sustain 
life.  It  will  be  useful,  therefore,  for  us  to  consider  at 
some  length  the  means  of  improving  and  Purifying 
the  Blood. 

The  products  of  tissue  waste  are  constantly  lique- 
fied and  carried  away  by  the  smallest  blood-vessels, 
called  capillaries  because  they  are  as  fine  as  and  even 


60 


finer  than  hairs.  If  these  waste  matters  should  re- 
main in  the  general  circulation  into  which  they 
enter  through  the  capillaries,  their  accumulation 
would  prove  a  serious,  perhaps  a  fatal  danger.  But 
they  are  constantly  eliminated  from  the  blood  by 
certain  organs,  while  passing  through  which  the 
blood  enters  another  set  of  capillary  vessels  having 
the  peculiar  function  of  separating  this  waste  mate- 
rial from  other  substances.  These  blood-purifying 
organs  are  the  lungs,  the  kidneys,  the  liver,  and  the 
skin.  Only  healthy  blood,  which  circulates  freely 
through  the  capillaries,  will  be  thus  purified. 

The  Lungs  remove  carbonic  acid  and  watery 
vapor  from  the  blood  and  transfer  them  to  the  air 
which  is  about  to  be  exhaled ;  while,  by  the  reverse 
process,  oxygen  is  inhaled  and  absorbed  by  the 
blood.  Here,  again,  pure  air  is  a  necessary  condi- 
tion for  the  proper  excretion  of  these  bodies. 

The  Liver  removes  a  large  amount  of  waste 
matter  from  the  blood,  principally  from  that  of  the 
portal  vein.  From  a  part  of  this,  mostly  from 
broken-down  blood  corpuscles,  the  Bile  is  formed. 
Bile  plays  an  important  part  in  the  digestion  of  fatty 
matter,  after  which  a  portion  of  it  passes  out  of  the 
system  by  way  of  the  bowels,  another  portion  how- 
ever being  reabsorbed  and  returning  to  the  liver. 
The  proper  activity  of  the  liver  is  sometimes  inter- 
fered with  by  pressure.    This  may  be  due  to  tight 


ei 

lacing,  or  to  belts,  or  to  sitting  continuously  in  a 
cramped  position.  Pressure  on  the  liver  and  abdo- 
men impairs  the  circulation  in  the  portal  vein,  and 
gives  rise  to  digestive  troubles,  piles,  and  other 
ailments. 

The  Kidneys  are  of  great  importance  in  the 
purification  of  the  blood,  since  the  waste  products 
of  albuminous  compounds  in  the  tissues  are  excreted 
by  them  in  the  form  of  urea  dissolved  in  water.  If 
tissue-changes  have  not  taken  place  normally,  or  if, 
for  some  reason,  the  oxygenation  of  these  products 
has  not  been  thoroughly  performed,  they  appear  as 
uric  acid,  or,  in  combination  with  alkalies,  as  urates. 
The  liquid  formed  by  these  processes  is  the  Urine. 
The  excretion  of  such  waste  materials  may  be  ma- 
terially assisted  by  the  free  use  of  pure  water  in 
drinking,  or  by  that  of  carbonated  and  mineral 
waters,  thus  assisting  the  purification  of  the  blood  ; 
or  by  that  of  alkalinic  waters  and  other  means  for 
neutralizing  the  excess  of  uric  acid  in  the  blood  and 
urine.  The  same  plan  may  be  followed  when  some 
affection  of  the  urinary  organs  exists,  the  object 
being  to  dilute  the  urine  and  thereby  render  it  less 
irritating  to  the  affected  parts. 

But  such  rules  do  not  hold  good  in  every  case. 
Very  fleshy  persons  should  not  imbibe  much  water 
or  other  liquids,  as  these  accelerate  digestion,  while 
such   persons  should  eat  little  and  digest  slowly. 


62 


Farthermore,  the  heart  is  overworked  by  the  in- 
creased blood  pressure  which  results  from  the  inges- 
tion of  large  quantities  of  fluid,  and  at  the  same 
time  the  lungs  are  interfered  with  in  their  respira- 
tory work. 


HYGIENE  OF  THE  SKIN. 

The  skin  does  its  share  in  the  work  of  purifying 
the  blood  by  means  of  its  gaseous  exhalations  and  of 
the  perspiration.  Its  other  functions  are  numerous. 
It  protects  the  sensitive  nerve  ends  through  whose 
agency  we  experience  the  sensation  of  touch,  and  it 
is  the  great  regulator  of  animal  heat.  Still  another 
use  is  that  of  respiration  :  Aubert  has  shown  by 
experiment  that  the  skin  gives  off  carbonic  acid  and 
absorbs  oxygen.  For  these  reasons  it  is  important 
that  it  should  be  well  cared  for.  The  temperature 
of  the  body  is  regulated  by  the  evaporation  upon  its 
surface  :  the  heat  necessary  for  the  evaporation  of 
the  water  in  the  capillaries  of  the  skin  is  drawn  from 
the  general  heat-supply  of  the  body.  The  greater 
the  amount  of  evaporation,  therefore,  the  greater  is 
the  reduction  of  temperature,  and  vice  versa.     This 


63 


regulation  of  bodily  heat  is  assisted  to  a  certain  ex- 
tent by  the  hair  upon  the  skin  and  by  the  dress. 

The  principal  requirement  for  a  normal  action  of 
the  skin  is  cleanliness.  To  this  end  frequent  Bathing 
and  change  of  clothing  are  indispensable.  In  cold 
weather,  however,  it  is  not  advisable  to  wash  the  ex- 
posed portions  of  the  skin,  the  face  and  hands,  too 
often,  nor  even  to  wash  them  in  cold  water  at  all. 
Lukewarm  water  should  always  be  made  use  of,  to- 
gether with  a  mild  soap,  the  alternative  being  the 
chapping  of  the  hands  and  face,  and  even  the  ap- 
pearance of  salt  rheum  or  eczema  upon  the  skin. 
When  frequent  washings  cannot  be  avoided  in  the 
winter  time,  the  exposed  portions  should  be  rubbed 
with  freshly  prepared  cold  cream,  vaseline,  or  gly- 
cerine. 

A  vapor  or  hot  air  bath  may  be  indulged  in  now 
and  then  as  a  means  of  thorough  cleansing ;  but  it 
should  never  be  undertaken  by  persons  affected  with 
lung  or  heart  diseases,  and  therefore  never  without 
the  advice  of  a  physician. 

The  Hair  of  the  scalp  and  beard  must  be  prop- 
erly cared  for.  The  use  of  some  fatty  substance, 
preferably  an  animal,  not  a  vegetable  fat,  is  bene- 
ficial. 

The  stronger  the  individual  constitution,  the 
thicker,  as  a  general  rule,  will  be  the  hair,  while 
in  sickly  persons  and  those  whose  blood  is  thin  the 


u 


hair  Is  badly  nourished  and  In  poor  condition,  I'he 
fatty  matter,  which  naturally  exudes  from  the  skin 
and  permeates  the  hair,  causes  it  to  remain  moist, 
soft,  and  pliable,  while  without  it  all  the  water  con- 
tained in  the  hair  would  evaporate  and  leave  the 
hairs  dry  and  friable.  The  careful  removal  of  dan- 
druff, which  owes  its  origin  mostly  to  dust  and  to 
the  use  of  certain  kinds  of  pomade,  is  absolutely 
necessary  to  the  growth  of  the  hair  and  to  its  proper 
lubrication  by  the  fatty  matters  of  the  skin.  The 
condition  of  the  scalp,  therefore,  is  of  very  materia] 
importance  to  the  growth  of  the  hair.  Washing  the 
scalp  with  spirits  is  unwise,  since  it  causes  great 
irritation  :  a  much  better  plan  is  to  use  the  yolk  of 
an  egg  or  diluted  honey.  Girls  and  women  should 
never  tie  their  hair  too  tightly,  nor  should  men  and 
boys  wet  theirs  nor  have  it  cut  too  often. 

Of  all  the  vicissitudes  our  skin  is  called  upon  to 
endure  the  most  frequent  and  the  most  carefully  to 
be  guarded  against  is  Exposure  to  Cold.  An  in- 
tense cold,  a  wind,  or  a  draft  of  air  striking  the  skin 
while  hot  and  perspiring,  causes  not  infrequently  a 
sudden  contraction  or  dilation  of  the  blood-vessels  in 
some  particular  organ,  resulting  in  what  we  call 
*^  taking  cold."  A  cold  may  be  contracted,  however, 
from  agencies  of  much  slower  operation,  as,  for  in- 
stance, from  wearing  too  thin  clothing,  from  throw- 
ing off  the  covers  while  sleeping  during  the  night, 


65 


from  sleeping  next  to  a  cold  wall  without  protection 

from  it,  from  living  for  a  long  time  in  cold  and  damp 
apartments,  from  standing  in  water  while  at  work, 
or  from  a  damp,  cold  atraosphere. 

Sheep's  Wool,  if  worn  next  the  skin,  protects 
directly  from  colds,  as  it  imbibes  the  perspiration 
quickly  by  reason  of  its  hygroscopic  properties  : 
thus  the  skin  remains  dry  and  the  seat  of  evapora- 
tion is  changed.  It  is  especially  advisable  for  those 
who  perspire  freely  to  wear  woolen  underclothing 
during  hot  weather.  The  best  preventive  against 
taking  cold  is  the  plan  of  keeping  the  feet,  the  back, 
and  the  abdomen  constantly  warm,  without,  how- 
ever, raising  too  much  the  temperature  of  other 
regions. 

Climate  should  influence  the  manner  of  living 
and  of  dress.  Our  feelings  as  to  temperature  in 
different  climates  depend  largely  upon  habit.  When 
the  inhabitants  of  temperate  climates  are  freezing, 
Esquimaux  feel  comfortable ;  and  when  the  former 
experience  comfort,  those  from  a  tropical  country 
are  apt  to  feel  cold. 

The  difference  between  black  Clothing  and  white 
is  well  known.  Black  absorbs  heat  rapidly,  while 
white  does  so  to  only  a  very  slight  degree.  The  for- 
mer color  is  therefore  best  adapted  to  cold  seasons 
and  climates,  the  latter  to  a  heated  atmosphere. 
Black  goods  also  possess  the  property  of  absorbing 


60 


with  facility  the  vapors  which  contain  infectious 
germs,  and  for  this  reason  dark  woolen  dresses  are 
inadmissible  for  nurses. 

Every  article  of  wearing  apparel  should  be  made 
sufficiently  large  to  admit  of  the  free  passage  of  air 
between  the  clothing  and  the  skin.  Evaporation 
and  consequent  coolness  of  the  skin  are  thereby  pro- 
moted. Clothing  of  ample  proportions  is  therefore 
to  be  recommended  during  the  hot  season,  as  well  as 
to  those  who  live  in  hot  countries.  But  loosely-cut 
clothing  is  also  very  agreeable  in  cold  weather  on 
account  of  the  disadvantages  of  tightly-fitting  ar- 
ticles, such,  for  instance,  as  gloves  and  shoes.  Most 
of  these  disadvantages  have  already  been  referred 
to :  it  is  enough  now  to  say  that  they  prevent  the 
circulation  of  air  next  the  skin,  and  so  do  not  keep 
the  wearer  as  warm  as  looser  clothing.  A  very  ob- 
jectionable and  even  dangerous  habit  is  that  of 
wearing  garments  which  compress  the  neck,  the 
chest,  or  the  region  of  the  stomach. 

The  Head,  being  partially  protected  by  hair, 
should  be  covered  only  lightly,  and  should  be  kept 
cool.  Only  heat,  cold,  and  wet  are  to  be  guarded 
against.  The  hat  should  be  very  light,  and  should 
not  fit  the  head  too  closely.  It  should  not  be  kept 
longer  than  strictly  necessary  upon  the  head,  and 
should  be  provided  with  due  means  of  ventilation. 
Failure  to  observe  the  above  rules  will  often  lead  to 


07 


baldness.  Hats  of  braided  horsehair  are  the  best  for 
summer  use,  but  preferably  a  parasol  should  be  used 
as  a  protection  against  the  rays  of  the  sun,  and  the 
hat  should  be  carried  in  the  hand. 

The  Neck  should  be  left  uncovered  from  child- 
hood up.  Stiff,  high  Cravats  and  Collars  ought  not 
to  be  worn,  but  only  such  as  are  large  enough  to 
admit  the  introduction  of  at  least  three  fingers. 
Paper  collars  are  often  impregnated  with  zinc  or 
lead,  and  may  become  dangerous  to  persons  who 
perspire  a  great  deal. 

The  Chest  should  be  clothed  in  garments  suffi- 
ciently loose  to  allow  of  full  expansion.  Tightly 
fitting  dresses  and  corsets  in  the  case  of  women,  and 
vests  or  coats  tightly  buttoned  up  to  the  neck,  are 
unhealthy  in  masculine  attire.  Suspenders  are  to 
be  considered  an  abomination,  especially  when  made 
of  inelastic  material.  In  France,  Austria,  and  some 
other  countries  suspenders  are  entirely  dispensed 
with  by  a  large  number  of  people,  because  the 
trousers  are  made  to  fit  closely  over  the  hips  and  the 
buckle  at  the  back  is  sufficient  to  control  them  so 
that  they  sit  comfortably  without  suspenders. 

The  Corset  is  used  in  a  most  unreasonable  man- 
ner so  frequently  that  the  wish  to  see  it  discarded 
absolutely  is  a  very  prevalent  one.  This,  however, 
is  not  to  be  expected,  and,  if  due  attention  be  paid  to 
the  rational  construction  and  sensible  wearing  of  the 


63 

garment,  Is  unnecessary.  At  all  events  young  girls 
should  not  be  allowed  to  wear  corsets  before  the  age 
of  puberty.  For  women  it  should  be  so  arranged 
that  the  region  just  below  the  ribs  may  not  be  com- 
pressed; for,  around  the  pit  of  the  stomach  are 
grouped  in  the  interior  of  the  body  the  most  im- 
portant vital  organs,  the  heart  and  lungs  above  the 
diaphragm,  and  the  liver,  stomach,  and  spleen  below 
it.  The  normal  action  of  these  organs  suffers,  of 
course,  by  compression. 

The  dire  effects  of  tight  lacing  are  very  evident 
in  some  cases:  the  liver,  and  sometimes  the  spleen, 
show  grooves  caused  by  the  pressure  of  the  ribs  and 
of  the  sharp  extremity  of  the  breast  bone.  How 
could  such  organs  continue  to  act  normally  ?  It  is 
impossible,  and  the  purification  of  the  blood  as  well 
as  the  formation  of  the  bile  are  impeded  by  the 
crippled  condition  of  the  organs  upon  which  they 
depend. 

The  surgeon  knows  very  well  the  -weakening 
effect  of  corsets  upon  the  muscles  they  compress. 
A  leg  just  released  from  a  plaster-of-paris  casing, 
which  has  held  it  far  more  loosely  than  a  corset,  is 
nevertheless  emaciated,  and  remains  weak  for  a  cer- 
tain time.  Still  more  does  the  corset,  instead  of  im- 
proving the  figure,  utterly  disfigure  it  by  rendering 
the  muscles  of  the  back  and  chest  more  or  less  in- 
capable of  use.     No  one  would  think  of  putting  a 


69 


paralyzed  arm  into  a  splint ;  on  the  contrary  one 
would  exercise  it,  employ  it,  apply  massage  to  it  : 
but  a  weak  back  we  swathe  in  bandages,  instead  of 
bathing,  rubbing,  and  exercising  it :  in  other  words, 
we  complete  the  paralyzing  process. 

A  second  effect  of  wearing  corsets  is  the  restraint 
they  impose  upon  the  movements  of  respiration.  If 
we  measure  with  a  spirometer  the  quantity  of  air 
which  can  be  inhaled  and  that  which  can  be  exhaled, 
we  find  that  from  twenty  to  thirty-four  per  cent, 
less  air  is  inhaled  beneath  a  tightly -fitting  corset 
than  when  the  corset  is  loosely  worn.  Such  a 
sequence  must  inevitably  deplete  the  circulation  and 
predispose  to  consumption. 

Another  effect  of  corsets  is  the  mechanical  pres- 
sure exerted  upon  the  contents  of  the  thoracic  and 
abdominal  cavities,  which,  according  to  numerous 
estimates,  should  weigh  in  the  adult  between  twelve 
and  eighteen  pounds.  This  weight,  which  rests  di- 
rectly upon  the  waistband,  bears  much  more  heavily 
upon  it  by  reason  of  the  constancy  of  the  pressure, 
while  it  causes  the  whole  structure  of  the  rib-wall  to 
be  displaced  and  the  liver  to  be  so  impinged  upon  that 
its  right  extremity  adheres  to  the  chest-wall  by  little 
more  than  a  single  thin  band  of  ligament.  The  up- 
ward effect  of  this  pressure  is  to  cause  stagnation  of 
blood  in  the  heart  and  lungs,  and  often  in  the  brain 
as  well :  the  downward  pressure  affects  organs  less 


70 

closely  adherent,  and  is,  therefore,  liable  not  only  to 
cause  similar  interference  with  the  blood  current,  but 
also  numerous  displacements  and  deformities.  In 
fine  the  maledictions  of  specialists  in  lung,  heart, 
stomach,  and  mental  diseases  alike,  and  above  all  of 
gynecologists,  are  wont  to  be  heaped  upon  this  sense- 
less article  of  fashion,  which,  like  many  another  in- 
strument of  torture,  is  said  to  owe  its  development 
to  Spanish  sources. 

"  The  more  nearly  a  woman's  waist  is  shaped  like 
an  hour-glass,  the  more  certainly  does  it  show  us 
that  her  sands  of  life  are  running  out." 

While  blood  accumulates  abnormally  within  the 
corset,  and  congestions  and  inflammations  of  the 
lungs  and  abdominal  organs  are  frequently  induced 
by  it,  deficiency  of  blood  and  resulting  coldness  pre- 
vail at  lower  levels.  For  the  same  reason  women 
err  also  in  wearing  the  Garter  below  the  knee.  This 
practice  undoubtedly  causes  coldness  of  the  feet  and 
throws  back  upon  the  body  a  portion  of  the  blood 
which  should  make  an  unhindered  circuit  of  the 
limbs.  Garters  should  never  be  worn,  but  when  per- 
sisted in,  should  be  placed  above  the  knees,  not  be- 
low them. 

The  Feet  are  frequently  tortured  by  tight  shoes, 
whose  pressure  impairs  their  healthfulness  of  func- 
tion. Cotton  stockings  are  preferable  except  for 
those  who  suffer  from  excessive  sweating  of  the 


71 


feet:  these  should  wear  woolen  stockings  constantly. 
Rubbers  and  arctics  are  very  useful  in  cold  and  wet 
weather,  but  should  always  be  removed  while  in  a 
warm  room.  Rubbers  are  not  to  be  recommended 
for  constant  wear,  because  they  interfere  with  proper 
ventilation  of  the  feet.  Two  pairs  of  shoes  are  de- 
sirable for  each  individual,  to  be  worn  on  alternate 
days,  since  a  single  night's  exposure  to  the  air 
is  usually  insufficient  to  free  these  articles  from 
moisture. 

All  articles  of  clothing  should  be  changed  as  fre- 
quently as  possible.  Especially  should  wet  garments 
be  replaced  by  dry  ones  as  soon  as  opportunity 
offers.  Cases  of  arsenical  poisoning  have  occasion- 
ally been  observed  as  a  result  of  wearing  goods  in 
whose  coloring  matter  arsenic  is  found.  Green 
colors  are  most  suspicious  in  this  connection. 

Many  refined  women  complain  that  equality  of 
rights  is  denied  them  and  that  they  are  thereby  kept 
in  subjection  to  the  male  sex.  The  greater  subjec- 
tion however  would  seem  to  be  that  which  they  en- 
dure of  their  own  accord.  A  woman  who  wishes  to 
appear  ladylike  must  pay  dearly  in  a  certain  species 
of  slave-chains :  for  the  iron-clad,  steel-plated  corsets 
which  prohibit  free  mobility  and  suppress  all  feeling 
of  personal  liberty,  the  painting  of  the  face,  the 
sleeves  which  fit  tightly  like  bands  about  the  arms 
and  restrain  motion  at  shoulder  and  elbow,  the  high 


73 


heeled  shoes,  more  than  all  that  enemy  of  comfort  in 
sitting,  the  bustle — by  what  other  name  shall  we  call 
these?  And  to  what  purpose  such  endurance?  Only 
to  disfigure  and  degrade  the  finest  piece  of  nature's 
handiwork,  lovely  woman.  Sensible  men  invariably 
prefer  the  natural  appearance  and  simplicity  of 
manner  to  those  artificial  ones  which  so  often  only 
serve  as  a  cloak  to  the  reality.  The  women  of 
ancient  Greece  were  far  wiser  in  this  regard  than 
those  of  a  later  day:  they  knew  full  well  that  health 
means  beauty,  and  they  acted  upon  this  knowledge. 

It  seems  to  us  full  time  for  the  refined  American 
lady  to  emancipate  herself  from  fashionable  hum- 
buggery  in  dress  and  to  send  a  real  declaration  of 
independence  from  a  senseless  tyranny  to  those  aris- 
tocratic dames  of  Continental  monarchies  who  at 
present  dictate  fashion.  By  so  doing,  no  doubt  she 
runs  the  risk  of  losing  the  sympathy  of  weak-minded 
dudes,  who  are  either  aristocrats  themselves,  or  who 
assume  aristocratic  airs ;  but  in  this  we  can  see  no 
disadvantage,  for  she  would  gain  thereby  the  respect 
of  men  who  are  genuine  representatives  of  republican 
intellect,  sense  and  character. 

We  cannot  too  strongly  deprecate  the  laying  of 
too  much  stress  upon  the  question  of  dress  and  upon 
external  appearance  in  general.  It  always  shows 
lack  of  good  taste,  and  it  may  in  the  end  undermine 
the  moral  nature  of  the  individual.    Children  should 


73 


be  brought  up  with  this  principle  in  view.  They 
should  never  be  restrained  by  dress  from  that  full 
Uberty  of  movement  which  ensures  perfection  of 
physical  development. 

But  while  we  thus  strongly  object  to  the  fashion- 
able attire  of  women,  we  must  not  be  understood  to 
maintain  that  the  dress  of  the  stronger  sex  is  any 
more  an  ideal  one.  The  style  of  dress  adopted  by  the 
ancient  Greeks  and  Romans  was  far  more  sensible 
and  practical,  especially  in  summer,  as  is  that  of  the 
Mohammedan  peoples  of  the  Orient  to-day,  admit- 
ting as  it  does  far  greater  liberty  of  movement. 
Among  our  own  people  the  costume  of  the  American 
mountaineer  may  be  commended  for  comfort  and 
convenience,  and  its  use  advocated  everywhere  in 
summer,  even  in  the  larger  cities. 

The  climate  of  America  is  a  milder  one  than  we 
or  our  ancestors  have  been  accustomed  to  in  Europe. 
Loose-fitting  clothing,  therefore,  is  more  appropriate 
here  than  there,  and  only  when  the  winter  season 
brings  a  return  of  arctic  rigors  should  resort  be  had 
again  to  the  bondage  of  high  collars,  gloves,  and  silk 
hats.  In  any  case  we  can  well  afford  to  do  away 
with  the  short  overcoat,  which  not  only  gives  a  ridic- 
ulous appearance  to  the  figure,  but  is  totally  inade- 
quate to  give  needed  protection  to  the  abdomen, 


LIGHT, 

Light  is  an  essential  of  life,  not  only  by  its  direct 
action  upon  the  skin  and  by  serving  as  the  medium 
of  vision,  but  also  indirectly,  because  through,  by, 
and  in  it  alone  can  the  development  of  oxygen  in 
the  vegetable  organism  take  place.  This  process 
results  in  the  exhalation  of  oxygen  by  the  leaves 
and  other  organs  of  the  plant,  while  they  inhale  and 
decompose  carbonic  acid  in  order  to  utilize  the  car- 
bon for  the  nourishment  of  the  organism.  Moleschott 
calls  both  flowers  and  fruits  "  children  of  the  light, 
woven  from  sunny  air."  They  are  condensed  sun- 
beams, so  to  speak.  With  vegetable  matter,  in  the 
form  of  coal  and  wood,  we  heat  our  rooms  ;  and  by 
using  vegetable  substances  as  food  we  are  enabled 
to  perform  muscular  work  and  exercise.  Thus,  light 
is  the  indispensable  medium  of  life,  while  plants, 
animals,  and  human  beings,  deprived  of  light,  it  has 
often  been  illustrated,  become  pale  and  emaciated 
and  soon  perish. 

'^Sunlight  aids  in  maintaining  the  purity  of  the 
atmosphere  by  the  part  it  takes  in  transforming  the 

74 


75 


chlorophyll  of  the  green  portions  of  plants.  By  its 
influence  the  air  is  freed  from  carbonic  acid,  whose 
poison  would  otherwise  collect  in  increasing  quanti- 
ties, and  which  it  replaces  with  invigorating  oxygen. 
So  eflScient  a  purifier  of  the  atmosphere  is  sunlight 
that  it  assists  the  oxidation  of  the  organic  materials 
it  contains  and  so  their  removal.  For  instance,  the 
musty  smell  which  strikes  one  so  disagreeably  in 
living  rooms  is  stronger  and  more  tenacious  in  north- 
erly rooms  than  in  those  which  face  southward  and 
which  are  consequently  exposed  to  the  sun.  Finally, 
sunlight  destroys  certain  microorganisms  in  their 
very  germs.  The  influence  exerted  by  lack  of  sun- 
light upon  the  development  of  disease  has  been  esti- 
mated from  statistics  collected  among  the  children 
reared  in  Rostock  at  the  public  expense.  Of  ninety- 
eight  such  children  twelve  were  affected  with  scrof- 
ula, that  precursor  of  consumption,  of  whom  four 
lived  in  cellars  and  five  in.  dark  attics,  where  the  sun 
could  not  penetrate.  And  in  Italy,  the  classical 
abode  of  that  disease,  the  origin  of  malaria  may  fre- 
quently be  traced  to  the  same  cause." 

The  air  of  a  well-lighted  room  is  better  than  that 
of  a  dark  one.  Thus  the  Italian  saying,  "  Where  the 
sun  does  not  enter  the  doctor  does,"  may  be  regarded 
as  tolerably  correct.  Sunlight  gives  courage  and 
hope  and  makes  us  glad,  free,  and  happy.  If  the 
sky  is  overcast,  if  fog  and  darkness  reign  supreme, 


76 


then  beware  of  melancholia,  of  hypochondriasis,  of 
despondency  bordering  upon  suicidal  mania. 

Too  much  sunlight,  however,  like  every  other 
excess,  works  harm.  The  weary  traveler,  wending 
his  way  through  the  southern  Sahara,  treads  upon 
sand  in  which  an  egg  is  hardened  within  a  few  min- 
utes. 'No  wonder  his  feet  are  soon  covered  with 
bhsters ;  no  wonder  the  exposed  portions  of  his  skin 
are  soon  scorched  and  blistered  too  by  the  merciless 
rays  of  the  fiery  orb. 

The  danger  from  exposure  to  heat  in  our  climate 
is  of  a  somewhat  different  kind.  In  our  large  cities 
we  are  affected,  not  only  by  the  direct  rays  of  the 
sun,  but  also  by  the  heat  that  is  reflected  from  the 
sun-scorched  walls  of  buildings  and  from  the  stones 
of  pavements  and  sidewalks.  In  open  country  the 
conditions  are  decidedly  better.  The  air  is  purer, 
and  the  lawns  and  meadows  and  woods  absorb  much 
of  the  heat,  so  that  radiation  is  much  diminished.  It 
is  in  accordance  with  this  suggestion  from  nature 
that  we  try  to  protect  ourselves  against  too  strong 
light  by  using  shades  for  our  eyes  to  reflect  the  rays 
of  heat  and  light.  For  a  similar  reason  also  it  is  that 
we  wear  light  clothes  in  summer. 


77 


HYGIENE  OF  THE  NERVOUS  SYSTEM. 

The  nervous  system  requires  food  that  is  rich  in 
albuminous  and  fatty  matter.  Phosphorus  is  abso- 
lutely indispensable,  since  nervous  tissues  contain  a 
large  amount  of  it,  partly  in  albuminous  compounds, 
and  partly  in  alkaline  phosphates.  Milk,  eggs  and 
meat  are  therefore  the  best  foods  for  nourishing  and 
strengthening  the  nervous  system,  together  with 
sufficient  quantities  of  fat  and  carbo-hydrates. 

The  circulation  of  blood  through  the  organs  of 
nervous  action  must  be  properly  regulated.  This 
maybe  achieved  by  suitable  exercise  and  deep  inspir- 
ations. Light,  warmth,  and  pure  air,  the  air  of  the 
forest  in  particular,  tend  to  improve  the  health  of 
these  organs. 

Any  organ  in  the  human  body,  if  put  to  but  little 
use,  gradually  diminishes,  it  is  found,  in  force  and 
energy,  continued  inactivity  leading  to  a  complete 
withering  of  its  substance.  In  like  manner  a  Brain 
kept  in  a  state  of  inactivity  loses  by  degrees  its  power 
of  perception  and  judgment.  This  is  best  illustrated 
in  certain  instances  where  children  have  grown  up 
among  animals,  without  any  intercourse  with  human 
beings.  Such  children  have  been  found  incapable  of 
speech,  unable  to  tell  right  from  wrong,  and  exhibit- 
ing no  trace  of  reason  :  their  feats  of  bodily  skill  and 


activity  however  are   superior  to  those  of  which 
most  animals  are  capable. 

Our  brains  are  best  nourished  and  strengthened 
by  work,  just  as  our  muscles  become  harder  and 
firmer  by  constant  use.  The  brains  of  men  who  have 
done  considerable  mental  work  during  life  show  some 
peculiarities  which  illustrate  this  principle  ;  the  sub- 
stance of  the  brain  is  of  unusually  hard  consistency, 
and  the  grey  matter  of  the  cortex  and  gyri  is  remark- 
ably developed.  It  seems  more  than  probable  that 
the  continually  increasing  size  of  the  human  skull, 
especially  of  its  anterior  portion,  is  due  solely  to 
the  progress  of  civilization.  The  human  race,  at 
least,  is  constantly  perfecting  its  intellectual  re- 
sources and  capabilities.  This  because  of  the  com- 
bined influences  of  heredity  and  education  which  are 
constantly  at  work,  moulding  and  shaping  men  and 
their  intellects,  their  brains  and  their  skulls. 

The  selection  of  brain  work  requires  a  great  deal 
of  care.  Beginning  with  easy  and  gradually  progress- 
ing to  harder  tasks  will  never  occasion  dangerous 
after  effects,  such  as  we  frequently  observe  in  chil- 
dren. Their  brains  are  normally  much  softer  and 
contain  a  larger  amount  of  liquid  contents  than  those 
of  adults,  and  they  should  therefore  be  very  carefully 
dealt  with.  Still  worse  is  the  experiment  so  often 
tried  in  our  schools  of  forcing  sickly,  anaemic  chil- 
dren to  the  same  rate  of  progress  with  those  who  are 


1^ 

« 

healthy.  For  the  former,  inasmuch  as  their  brain- 
substance  is  poorly  nourished,  are  far  too  slow  to 
satisfy  their  instructors,  and  in  some  instances  are 
entirely  unfit  for  mental  effort.  This  sort  of  forcible 
intellectual  training,  of  which  many  parents  and 
many  teachers  are  guilty,  is  the  more  harmful  to  a 
growing  brain,  the  less  satisfactory  are  the  external 
conditions  surrounding  the  child,  such  as  improper 
feeding,  poor  liying,  and  insufficient  rest.  ISTothing 
is  so  hurtful  to  a  brain  as  disproportion  between  work 
and  rest.  Mental  vigor  is  always  impaired  by  over- 
exertion at  hard  and  long-continued  labor,  by  irrita- 
tion from  frequent  and  unnaturally  violent  nervous 
impressions,  by  want  of  sleep,  or  by  severe  intellect- 
ual effort. 

Among  the  causes  of  unnatural  excitement  alco- 
holic liquors  play  an  important  part.  At  first  they 
seem  to  enliven  and  stimulate  the  brain  to  greater 
activity,  but  soon  the  weakening  and  depressing 
effects  manifest  themselves. 

Sleep  is  absolutely  indispensable  to  maintaining 
the  normal  composition  of  the  brain  substance  and 
thereby  to  the  proper  supply  of  brain  force.  The 
more  work  the  brain  has  accomplished,  the  more 
sleep  is  necessary  for  recuperation.  Sleep  will  re- 
fresh and  invigorate  the  brain,  as  well  as  the  nerv- 
ous and  muscular  systems,  only  when  it  lasts  suffi- 
ciently long,  and  when  it  is  uninterrupted,  sound, 


80 


and  quiet.  To  fulfil  these  conditions  must  therefore 
be  our  aim.  Attention  must  consequently  be  paid, 
not  only  to  the  frequency,  the  regularity,  and  the 
length  of  the  period  in  sleep,  but  also  to  the  sur- 
roundings during  sleep. 

The  Bedroom  should  be  spacious,  moderately 
warm,  and  quiet,  and  its  air  should  be  kept  dry  and 
pure.  It  should  face  toward  the  south,  and  should 
be  as  far  removed  as  possible  from  all  damp,  mouldy, 
and  ill-smelling  localities.  If  one  person  sleeps  alone 
in  a  large  room  whose  window  he  does  not  wish  to 
keep  open  over  night,  he  should  at  all  events  thor- 
oughly ventilate  the  apartment  for  some  length  of 
time  before  retiring.  But  when  several  persons 
sleep  in  the  same  room  the  air  can  only  be  kept  pure 
by  constant  Ventilation.  Leaving  the  windows  open 
all  day  long,  but  closing  them  at  night,  does  not 
afford  sufficient  change  of  air.  In  a  badly  ventilated 
bedroom  one  is  extremely  liable  to  inhale  the  floating 
germs  of  disease  and  other  noxious  particles  during 
sleep.  For  this  reason  perhaps,  infectious  diseases 
occur  much  more  frequently  in  winter,  when  venti- 
lation is  not  so  thorough  as  in  warmer  seasons,  most 
persons  being  unreasonably  afraid  on  account  of  the 
cold.  Good  ventilation  however  tends  rather  to  estab- 
lish currents  of  air,  which  remove  these  germs  com- 
pletely, or  at  least  in  large  part ;  and  even,  should 
some  enter  the  body,  the  latter  will  be  in  better  condi- 


8] 


tion  to  resist  their  action  on  account  of  its  increased 
supply  of  oxygen.  Perhaps  also  the  germs  are  ren- 
dered harmless  in  a  mechanical  way  by  good  ventila- 
tion; while  in  impure  and  damp  air,  where  respiration 
is  not  so  well  sustained,  germs  which  have  already 
been  inhaled  are  less  likely  to  continue  floating  in 
the  inspired  air  and  to  be  exhaled  with  it  before 
effecting  a  lodgment.  Healthy  individuals  can  surely 
sleep  with  open  windows,  when  in  some  English  and 
German  hospitals  the  sick  are  compelled  to  do  so  to 
their  great  benefit,  the  only  precaution  taken  being 
to  avoid  a  draft  directly  upon  the  person.  In 
various  German  institutions  for  the  treatment  of 
consumptives  it  is  an  inflexible  rule  that  patients  are 
not  allowed  indoors  :  not  only  do  they  lie  upon  cots 
in  the  open  air  all  day,  but  at  night  they  are  re- 
moved into  open  tents  ;  this  treatment  being  attend- 
ed by  the  most  gratifying  results. 

In  regions,  however,  where  intermittent  or  yellow 
fever  prevails,  and  where  various  forms  of  malaria 
are  indigenous,  ventilation  must  be  very  carefully 
regulated,  the  windows  being  opened  only  during 
the  day,  for  at  night  the  poisonous  exhalations  from 
the  ground  are  most  active,  especially  if  rain  has 
fallen  shortly  before.  And  indeed,  under  all  circum- 
stances it  is  safer,  when  windows  are  left  open,  to 
sleep  in  a  room  as  far  as  possible  from  the  ground. 
These  rules  become  less   imperative  after  a  long 


83 


drouth  and  during  continuous  rain  or  cold  northerly 
winds. 

In  winter  time  in  our  climate  the  stove  is  a  bad 
neighbor  so  far  as  the  supply  of  fresh  air  is  con- 
cerned, for  it  needs  a  great  deal  of  oxygen,  twenty- 
four  times  as  much  as  a  man,  and  this  it  robs  from 
its  human  room-mates,  only  to  return  them  an  occa- 
sional whiff  of  smoke  mingled  with  treacherous 
gases.  But  ventilation  will  overcome  all  this,  if 
sleeping  in  a  cold  room  is  not  considered  desirable. 
When  the  windows  are  open,  enough  oxygen  will  be 
supplied  to  the  sleepers  as  well  as  to  the  stove. 

All  lights  should  be  extinguished  before  retiring, 
as  their  presence  is  irritating,  not  only  to  the  eye, 
but  also  to  the  brain.  The  worst  of  all  lights  to 
sleep  by  is  a  gas  light,  unless  turned  quite  low,  for  a 
strong  gas  jet  consumes  twelve  times  as  much  oxy- 
gen as  a  man,  and  for  this  reason  it  should  at  all 
times  be  avoided  where  ventilation  is  not  good. 

A  few  other  points  may  be  referred  to  in  connec- 
tion with  sleep.  The  covers  should  be  drawn  up 
over  the  stomach  in  order  to  keep  it  warm.  For 
full-blooded  persons  the  pillow  should  be  moderately 
high,  so  that  the  head  is  raised  above  the  level  of  the 
body.  In  the  case  of  the  anaemic,  however,  it  is 
generally  better  to  sleep  with  the  head  lower,  and 
even  on  a  level  with  the  body.  Lying  upon  the  back 
is  to  be  avoided,  since  it  may  cause  irritation  of  the 


83 


spine  and  consequent  nervous  excitements.  When 
constipation  exists,  physic  should  be  taken  at  such  a 
time  that  its  effect  will  not  disturb  the  night's  rest. 
Other  natural  desires  should  be  heeded  at  once,  be- 
cause quiet  sleep  is  impossible  unless  this  be  done. 

Another  rule  indispensable  to  good  health  is, 
never  to  sleep  upon  a  feather  bed.  Owing  to  the 
non-conductive  properties  of  feathers,  the  gases  of 
the  body,  so  detrimental  to  the  human  system,  accu- 
mulate within  the  soft  mass.  Moreover  these  beds 
are  the  general  reservoirs  of  the  various  exhalations 
from  different  bodies  which  have  lain  upon  them. 
Hence  husk,  palm-leaf,  or  hair  mattresses  should  be 
adopted  in  their  place. 


HYGIENE    OF    THE    EYE. 

The  eye  of  the  newborn  infant  should  be  ex- 
posed only  very  gradually  to  the  light.  Moderate 
light  and  darkness  alternating  suddenly  are  as  hurt- 
ful as  intense  light  alone.  In  childhood  the  eyes 
should  be  protected  from  sunlight  by  a  hat  with  a 
broad  brim.  Very  brilliant  or  glittering  objects 
should  not  be  looked  at  for  any  length  of  time.  Dur- 
ing sleep,  as  well  as  immediately  upon  awakening, 


84 


the  child's  eye  should  not  be  exposed  to  strong  light. 
In  school,  children  should  be  taught  very  carefully 
how  to  use  their  eyes.  They  should  never  be  allowed 
to  read,  write,  or  draw  in  an  insufficiently  lighted 
room:  there  is  nothing  that  will  injure  the  eyes  more 
seriously  nor  more  rapidly  than  a  failure  to  comply 
with  this  rule,  and  yet  none  is  more  frequently  sinned 
against.  Often  the  supply  of  light  in  school  rooms  is 
very  poor,  not  exceeding  the  light  of  dawn.  Often 
also  reading,  writing,  or  drawing  is  practiced  after 
sundown  or  by  a  poor  artificial  light.  Blackboards 
should  never  have  shiny  surfaces:  a  dull  one  is  pref- 
erable. The  most  important  recommendation,  how- 
ever, is  this:  never  continue  for  a  long  time  those 
occupations  which  require  the  constant  use  of  a 
child's  eyes.  It  is  actually  a  crime  to  require  chil- 
dren to  write  and  read  and  sew  and  draw  for  hours  at 
a  time.  Gothic  type,  such  as  is  used  in  Sweden  and 
Germany,  is  very  trying  to  the  eye,  much  more  so 
than  the  Roman  type  in  use  with  us,  and  it  should 
therefore  be  discarded,  especially  in  the  schools.  The 
small  type  employed  by  many  American  news- 
papers is  another  evil  to  be  condemned.  In  reading 
while  lying  down  it  is  hardly  possible  to  hold  the 
book  in  a  favorable  position,  so  that  the  external 
muscles  of  the  eye  are  almost  inevitably  subjected 
to  strain.  In  addition  to  this,  when  the  head  is  on  a 
level  with  the  body  instead  of  erect  there  is  a  ten- 


85 


dency  to  the  flow  of  an  excess  of  blood  toward  the 
eyes.  Fine  embroidery,  lacework,  and  fine  needle- 
work in  general,  being  notoriously  destructive  to  the 
eyes,  should  be  forbidden,  and  especially  preparing 
Christmas  presents  in  this  way.  When  selecting  an 
occupation  or  business  for  a  young  man,  the  condi- 
tion of  the  eyes  should  be  considered  much  more 
generally  than  is  at  present  the  custom.  In  select- 
ing eyeglasses  a  physician  should  always  be  con- 
sulted, and  the  purchase  should  be  made  from  a 
reliable  optician. 

The  eye  is  affected  very  unfavorably  by  light 
strongly  reflected  from  such  surfaces  as  snowfields, 
sandy  plains,  limestone  cliffs,  bodies  of  water,  walls 
painted  with  light  colors  in  oil,  smooth  French  floor- 
ing, polished  furniture,  and  other  shining  objects. 
The  best  means  of  protection  against  this  reflection 
of  light  lies  in  the  use  of  blue  and  other  colored 
glasses,  of  blue  veiUngs,  and  of  white  parasols  with 
blue  hnings.  Frequent  closing  of  the  eyes  or  fixing 
them  upon  objects  which  are  in  the  shade  or  which 
have  a  dull  color,  are  measures  farther  to  be  recom- 
mended. The  fact  should  always  be  kept  in  mind 
that  a  strong  light  is  much  more  easily  borne  when 
it  comes  from  above  than  when  it  strikes  the  eyes 
from  below  or  from  the  side. 

Since  natural  light  is  less  fatiguing  to  the  eye 
than  artificial  light,  and  since,  as  a  rule,  it  strikes  the 


86 


eye  from  above,  every  task,  including  reading,  should 
be  performed,  so  far  as  possible,  by  daylight,  and 
artificial  light  should  be  made  use  of  principally  for 
pastimes  and  for  easier  employments,  where  little 
strain  is  put  upon  the  eyes.  And  even  this  only  up  to 
a  reasonable  hour  in  the  evening.  The  use  of  artifi- 
cial light  is  not  only  obnoxious  to  the  eye,  but,  by 
radiating  warmth,  and  by  the  bent  position  of  the 
head,  it  is  hurtful  also  to  the  brain  and  to  the  whole 
body,  as  we  see  notably  in  cases  of  insolation  in 
those  who  work  in  factories  by  gaslight.  The  direct 
rays  of  the  sun  too  are  hurtful.  The  best  light  is 
obtained  when  there  are  a  few  thin  clouds  over  the 
sun  to  act  as  a  shade  and  reflector  and  so  to  increase 
the  perspective.  Dover  and  Calais  can  very  seldom 
be  seen  simultaneously,  and  then  only  when  thin 
clouds  cover  the  sun. 

Since  the  visual  power  of  the  eyes  is  limited,  as 
are  the  functions  of  all  our  organs,  and  to  a  greater 
degree  before  adult  life  is  reached,  they  should  never 
be  used  up  to  the  point  of  fatigue.  When,  neverthe- 
less, an  exacting  employment  of  the  visual  power  is 
required  by  force  of  circumstances,  a  systematic 
change  of  occupation  should  be  practiced,  for  the 
eye  will  bear  much  more  work,  if  the  objects  to  be 
looked  at  are  changed  at  certain  intervals.  But  the 
best  safeguard,  of  course,  is  occasional  complete  rest. 


87 


HYGIENE  OF  THE  EAR. 

The  external  auditory  canal  requires  frequent 
cleansing,  but  always  with  caution.  It  quite  often 
becomes  filled  with  hardened  wax,  causing  difficulty 
in  hearing  or  even  deafness.  Such  an  accumulation 
may  be  removed  by  softening  it  with  sweet  oil  and 
then  syringing  the  ear  with  warm  water.  Hard 
instruments  must  never  be  employed  in  unskilled 
hands  for  fear  of  injuring  the  delicate  internal 
structures. 

The  ear  should  be  protected  from  drafts,  espe- 
cially when  the  individual  feels  very  warm  :  other- 
wise inflammation  may  set  in  and  destroy  the  drum 
membrane.  The  same  is  true  in  regard  to  cold  water. 
Many  cases  of  inflammation  of  the  middle  ear  have 
resulted  from  the  forcible  entrance  of  cold  water  into 
the  ear.  If  the  inflammation  is  transmitted  to  the 
membranes  surrounding  the  brain,  death  is  likely  to 
result.  Caution  must  always  be  exercised  whenever 
an  abnormal  discharge  is  found  to  be  issuing  from 
the  ear,  for  the  simplest  inflammxation  may  spread  to 
the  air-cells  in  the  bone  behind  the  ear,  and  so  give 
rise  to  dangerous  symptoms.  Not  only  under  such 
circumstances,  but  in  any  case  of  severe  ear-ache,  a 
physician  should  be  promptly  consulted,  for,  failing 
an  exit  to  the  outer  ear,  a  gathering  of  pus  may  force 


88 


its  way  into  the  cranial  cavity  and  form  an  abscess 
there.  Blows  in  the  region  of  the  ear  are  very  dan- 
gerous, their  force  sometimes  being  sufficient  to  cause 
paralysis  of  the  nerve  of  hearing,  and  consequent 
deafness.  This  is  not  infrequently  the  result  of  the 
"boxed  ears"  or  the  "tweak  of  the  ear"  so  often 
administered  by  thoughtless  parents  and  teachers. 


HYGIEKE  OF  THE  NOSTRILS. 

The  seat  of  the  special  sense  of  smell  is  in  the 
upper  part  of  the  nasal  cavity,  where  the  olfactory 
nerve  expands  into  numerous  filaments  in  the  mu- 
cous membrane.  This  region  must  therefore  be  pro- 
tected from  disease. 

The  nose  of  a  child  should  be  frequently  and 
thoroughly  cleansed.  Picking  and  boring  with  the 
fingers  should  be  forbidden,  as  well  as  the  introduc- 
tion of  foreign  bodies.  Very  cold  air  or  air  con- 
taining irritating  substances,  such  as  dust  or  smoke, 
should  be  avoided,  as  they  are  apt  to  produce  nasal 
catarrh,  commonly  called  a  cold  in  the  head.  When 
smelling  a  flower,  it  may  happen  that  an  ipsect  is 


89 


drawn  up  into  the  nose :  this  too  must  be  guarded 
against.  Excessive  use  of  strong  snuff  is  injurious 
to  the  sense  of  smell. 


HYGIENE  OF  THE  TASTE. 

The  tongue  is  the  principal  organ  of  taste.  It 
may  lose  this  property  wholly  or  in  part,  if  its  mu- 
cous membrane  is  changed  in  any  way,  the  papillae, 
the  little  wart-like  excrescences  which  contain  the 
terminal  filaments  of  the  gustatory  nerve,  becoming 
degenerated,  or  the  nerve  endings  themselves  becom- 
ing excessively  irritable. 

The  tongue  must,  therefore,  be  protected  from  the 
action  of  burning,  irritating,  and  sharp  substances, 
like  tobacco,  spices,  and  pickles,  and  from  food  and 
drink  which  is  either  too  hot  or  too  cold.  The  sharp 
edges  of  broken  teeth  may  injure  the  tongue  me- 
chanically, and  a  similar  effect  may  follow  coughing 
in  infants  who  have  acquired  only  the  first  two 
teeth,  because  the  tongue  is  protruded  with  every  fit 
of  coughing  and  rubbed  over  the  upper  edges  of 
these  teeth. 


90 


HYGIENE  OF  THE  VOICE. 

The  air  which  we  inhale  passes  through  the 
throat  and  on  either  side  of  the  vocal  cords.  It 
should  therefore  never  be  of  an  irritating  nature, 
because  catarrhal  inflammation  of  the  throat,  with 
hoarseness  and  cough,  is  apt  to  be  caused  in  this 
way.  Cold  air  must  be  avoided,  as  well  as  air  con- 
taining particles  of  dust,  smoke,  especially  tobacco 
smoke,  and  such  gases  as  chlorine,  ammonia,  and 
illuminating  gas.  If  catarrh  of  the  throat  occurs 
repeatedly  in  an  individual,  and  it  usually  is  quite 
obstinate  and  sometimes  of  long  duration,  the  mu- 
cous membrane  of  the  vocal  cords  becomes  con- 
siderably thickened  and  the  voice  acquires  a  peculiar 
hoarseness,  its  softness  and  metallic  ring  being  lost. 
Catarrh  may  be  easily  produced  by  exposure  to  cold 
air  after  any  considerable  exertion  of  the  voice  in 
singing,  or  after  loud  and  prolonged  speaking  in  a 
heated  room.  Under  such  circumstances  it  is  a  good 
plan  to  protect  the  throat  by  a  shawl  or  scarf,  and 
by  keeping  the  mouth  closed,  so  that  the  inhaled  air 
is  partially  warmed  and  filtered  in  passing  through 
the  nostrils.  Food  and  drink  may  also  act  injuri- 
ously upon  the  throat,  if  taken  very  hot  or  very  cold. 


91 


or  if  of  an  irritating  nature,  such,  for  instance,  as 
strongly  spiced  or  very  sour  foods.  Alcoholic  liquors 
frequently  have  the  same  effect,  particularly  when 
taken  immediately  after  meals.  After  exertion  of 
the  throat  ice-cold  drinks  are  always  hurtful.  It  is 
well  to  be  careful  about  everything  that  is  to  be 
swallowed.  Saliva  which  contains  tobacco-juice 
must  be  carefully  guarded  against,  as  well  as  small 
sharp  bodies,  bones,  and  the  skins  of  fruit  and  vege- 
tables. The  throat  should  never  be  subjected  to 
prolonged  exertion  in  loud  singing  and  speaking, 
because  not  infrequently  a  very  decided  weakness  of 
the  voice  may  result.  This  has  been  known  to  be- 
come incurable,  as  many  singers  and  vocalists  have 
learned  to  their  cost,  not  a  few  splendid  voices  hav- 
ing been  ruined  in  this  manner.  The  throat  also 
requires  protection  externally,  but  should  never  be 
wrapped  in  very  tight  or  very  warm  apparel.  If 
heated  and  perspiring,  however,  it  should  not  be  ex- 
posed suddenly  to  cold.  The  best  way  of  rendering 
the  throat  insusceptible  to  changes  of  temperature  is 
to  become  accustomed  to  cold  ablutions  and  to  wear 
collars  and  clothing  very  low  in  the  neck,  so  that 
the  throat  becomes  hardened  to  exposure.  The  sub- 
jecting of  other  regions  of  the  body,  for  example,  of 
the  feet,  to  cold  and  like  harmful  influences  is  to  be 
guarded  against,  for  in  this  way  inflammation  of  the 


92 


throat  may  be  occasioned  through  reflex  nervous 
action.  Fresh  air  and  exercise  benefit  the  voice  by 
their  effect  upon  the  muscular  system  in  general, 
a  consideration  which  should  lead  every  vocalist  to 
givQ  special  attention  to  physical  training. 


HYGIENE  OF  THE   MUSCLES. 

A  proper  alternation  between  exercise  and  rest  is 
a  prime  necessity  for  a  healthy  condition  of  the 
muscular  system.  Muscular  fatigue  is  caused  by 
the  accumulation  in  the  muscles  of  waste  products, 
which  are  formed  more  rapidly  by  exertion  than 
they  can  be  carried  away  in  the  blood-stream.  But 
there  is  still  another  source  of  fatigue.  The  oxygen 
necessary  to  the  proper  performance  of  muscular 
work  is  present  in  the  muscle  beforehand,  and  its 
store  cannot  be  replenished  during  exercise.  When 
therefore  the  amount  of  oxygen  present  is  exhausted, 
fatigue  begins.  A  fatigued  muscle  is  physically  and 
chemically  different  from  what  it  was  before  its  task 
was  commenced.  Kest  alone  can  restore  it  to  its 
former  condition. 

By  the  constantly  alternating  pressure  which  a 


9S 


contracting  muscle  exerts  on  the  blood  and  lymph 
vessels  in  its  neighborhood  the  circulation  of  these 
liquids  is  accelerated,  the  current  in  the  veins, 
which  return  the  blood  from  the  general  system 
to  the  heart,  being  particularly  influenced.  It  is 
well  known  that,  when  attention  is  concentrated 
upon  certain  nerves  and  muscles,  the  muscular 
exertion  relieves  the  tension  of  the  brain;  and  thus 
the  fact  is  explained  that  hard  bodily  work  and  con- 
tinued muscular  exercise  free  the  mind  temporarily 
of  many  of  its  cares.  The  elimination  of  waste 
material  takes  place  chiefly  during  rest,  and  mostly 
through  the  kidneys  in  the  form  of  urea,  as  we  have 
already  seen.  At  this  time  the  flow  of  blood  to  the 
muscles  increases,  new  material  is  furnished  them 
in  abundance,  and  new  muscle  and  nerve  substance 
is  formed  in  store  for  future  demand. 

Muscular  exercise  is  of  paramount  importance, 
for  every  movement  and  almost  every  activity  of  the 
body  is  due  to  muscular  exertion.  The  same  agency 
farthermore  generates  manual  dexterity  and  force, 
strengthens  the  will,  quiets  the  brain,  helps  develop 
the  bones  of  the  frame,  and  assists  greatly  those  im- 
portant physiological  processes,  circulation  and 
purification  of  the  blood,  the  movements  of  respira- 
tion, and  digestion. 

By  overexertion  much  harm  may  be  done,  weak- 
ness induced  amounting  almost  to  palsy,  enormous 


Oi 


development  of  tlie  muscular  system  effected  at  the 
expense  of  other  organs,  particularly  the  brain, 
which  then  becomes  very  slow  and  dull,  anaemia 
developed  in  consequence  of  overtaxing  of  the  blood, 
enlargement  of  the  heart  brought  about  with  palpita- 
tion, and  dilatation  of  the  lungs  with  asthma.  Dis- 
figurements and  deformities  of  various  kinds  are 
likely  to  result,  when  certain  parts  only  of  the 
muscular  system  are  used.  Frequent  and  rational 
use  of  a  muscle,  followed  by  sufficient  rest,  will 
make  it  plump,  hard,  and  strong,  while  continuous 
inactivity  renders  it  flabby,  thin,  and  at  last  fatty. 

Subjoined  are  certain  Rules  to  be  Observed  dur- 
ing Exercise.  All  tight  clothing,  especially  about 
the  neck  and  chest,  must  be  removed.  The  various 
sets  of  muscles  should  be  trained,  and  therefore  the 
movements  must  involve  all  the  joints,  alternating 
systematically.  The  muscles  of  respiration  and 
those  of  the  abdomen  should  be  particularly  remem- 
bered. The  various  troubles  of  the  digestive  organs 
are  thus  favorably  influenced,  and  affections  of  the 
heart  and  lungs  successfully  combated,  inasmuch 
as  a  narrow  chest  may  be  broadened  by  rendering 
the  contractions  of  the  respiratory  muscles  more  effi- 
cient. 

Extreme  fatigue  should  never  be  induced.  As 
soon  as  there  is  an  appreciable  feeling  of  fatigue, 
exercise  should  be  suspended.  Although  the  number 


05 


of  working  hours  in  Europe  exceeds  that  customary 
in  the  United  States,  the  amount  of  work  performed 
here  is  greater  and  produces  more  fatigue.  Rest 
should  continue  until  all  feeling  of  fatigue  is  gone. 

The  intensity  and  duration  of  the  movements 
practiced  must  be  increased  very  gradually,  if  in- 
crease of  muscular  strength  is  desired.  Nutrition 
must  be  proportioned  to  the  activity  of  the  body, 
otherwise  the  system  will  succumb.  Poor  diet  will 
always  tell  at  last,  because  income  and  expenditure 
are  not  equalized.  Pure  air  and  full  breathing  are 
required  during  and  after  exercise :  the  latter  not 
only  promotes  change  of  air  in  the  lungs,  but  also 
quickens  the  functions  of  circulation  and  digestion. 
As  soon  as  rapid  respiration  and  palpitation  set  in 
exercise  should  cease ;  also  when  headache,  dizzi- 
ness, and  other  disagreeable  sensations  are  present, 
when  the  face  becomes  pale  and  pinched  or  flushes 
suddenly,  or  when  a  feeling  of  great  heat  or  ex<jes- 
sive  prespiration  sets  in.  People  who  suffer  from 
heart  or  lung  diseases  must  be  particularly  cautious 
as  to  exercise.  Eating  must  be  avoided  shortly  be- 
fore or  shortly  after  any  considerable  exertion,  as 
digestion  is  thereby  impaired.  Exposure  to  cold  on 
such  an  occasion  is  especially  injurious  to  the  heart. 
When  not  in  a  position  to  practice  muscular  exer- 
cise, massage  of  the  muscles  should  take  its  place. 

If  the  above  rules  are  followed  closely,  the  salu- 


96 


tary  effects  of  exercise  will  be  speedily  experienced. 
Affections  of  the  brain  and  nervous  organism  of  a 
functional  nature,  such  as  hysteria,  hypochondriasis, 
melancholia,  sleeplessness,  and  despondency,  will 
soon  disappear.  Disturbances  of  the  circulation  will 
be  improved  or  wholly  cured,  since  the  heart  and 
blood-vessels  are  enabled  to  contract  more  forcibly. 
The  blood  will  become  healthier,  because  the  waste 
material  is  carried  off  more  efficiently.  Persons  suf- 
fering from  gout,  rheumatism,  or  obesity  will  feel  as 
though  created  anew,  and  anaemic  and  chlorotic 
girls  will  regain  their  color  and  lose  the  curvatures 
and  deformities  of  the  spine  which  are  due  to  mus- 
cular weakness. 

Healthy  exercise  is  best  obtained  through  such 
sports  as  rowing,  skating,  swimming,  fencing, 
tennis-playing,  bicycling,  and  horse-back  riding. 
Dancing  in  itself  is  a  healthy  exercise,  but  it  is 
almost  invariably  overdone,  and  the  surrounding 
conditions  are  decidedly  unfavorable ;  no  rest  is 
taken  between  the  dances  ;  it  is  indulged  in  at  night 
after  a  proper  bed-time,  in  tightly  fitting  dresses, 
and  in  hot,  dusty,  poorly  ventilated  halls,  crowded 
with  people;  then  also  it  lasts  too  long,  and  too 
much  drinking  is  habitually  indulged  in  at  balls, 
parties,  and  similar  assemblages.  Dancing  on  plat- 
forms erected  in  the  open  air  in  shady  places,  pref- 
erably in  the  woods,  is  far  less  objectionable.     The 


97 


action  of  cold  upon  the  skin  and  lungs  is  much  to  be 
dreaded,  and  sudden  changes  of  air  when  dancing 
must  be  carefully  guarded  against. 

Gymnastics  and  Mountain-climbing  are  upon 
the  whole  the  best  methods  of  exercise,  provided 
the  rules  we  have  given  are  acted  upon.  The  air 
in  large  cities  is  far  from  possessing  the  purity  desir- 
able to  practice  athletic  exercises  in,  and  it  is  better 
on  this  account  to  establish  the  gymnasium  in  the 
upper  part  of  the  house. 

Calisthenics  are  coming  more  and  more  into  use 
every  day  for  ladies  and  girls,  although  much  still 
remains  to  be  done  toward  their  perfection.  This  is 
a  branch  of  education  which  deserves  wider  atten- 
tion— not  only  that  it  is  much  more  healthy  than 
many  semi-superfluous  theoretical  studies;  but  it 
actually  tends  to  improve  the  complexion  and  beau- 
tify the  face  and  figure. 

iSTothing  should  be  regarded  as  of  greater  impor- 
tance than  healthy  exercise,  and  there  is  no  exercise 
preferable  to  mountain-climbing.  Here  a  variety 
of  favorable  conditions  obtain,  healthy  ground,  pure 
air,  a  healthful  mode  of  exercise  promotive  of  vigor- 
ous respiration  and  digestion,  and  the  profound  en- 
joyment and  equanimity  which  accompany  the 
constantly  changing  aspects  of  beautiful  and  ma- 
jestic landscapes.  In  mountain-climbing  accord- 
iagly,   to    the    directly    beneficial   effect    upon  the 


08 


health  of  the  individual  we  find  added  the  peculiar 
gratification  enjoyed  by  every  lover  of  nature.  It 
is  to  be  regretted  that  only  one  Alpine  club,  of  the 
kind  so  prevalent  in  many  countries  of  Europe,  at 
present  exists  in  this  country  :  we  are  given  to 
understand,  however,  that  a  second  is  about  to  be 
organized,  and  it  is  to  be  hoped  that  many  more 
may  follow. 

Some  extracts  from  an  article  published  by  the 
present  author  in  the  New  York  Medical  Journal 
will  detail  more  explicitly  the  good  effects  of  moun- 
tain-climbing. 

"The  strengthening  and  invigorating  effect  of 
exercise,  and  especially  of  mountain  -  climbing,  is 
warmly  to  be  commended.  For  the  latter,  by  the  relief 
it  gives  from  the  cares  of  business,  combined  with 
residence  in  a  healthful  locality,  active  respiration 
of  pure  air,  and  the  drinking  of  pure  water,  exerts 
not  only  a  transitory  beneficial  effect,  but  even,  in 
most  cases,  leads  to  permanent  cure  of  disease  or 
tends  to  prevent  its  occurrence.  The  best  inhalation 
apparatus,  baths,  and  medicaments  are  of  but  tem- 
porary value,  if  no  compensation  is  made  for  the  loss 
of  vitality  and  of  muscular  tone,  especially  that  -of 
the  heart  and  blood-vessels  ;  if  the  blood-stasis  in 
the  glands  and  other  organs  does  not  yield  to  an  in- 
creased flow  of  blood  in  arteries  and  veins ;  if  the 
thinned  blood  does  not  become  thicker  and  more  rich 


00 


In  albumen ;  if  the  accumulating  carbonic  acid  is  not 
expelled  by  a  more  plentiful  supply  of  oxygen ;  if 
the  fat  deposited  in  the  body  is  not  more  rapidly 
oxidized  ;  and  if  the  kidneys  are  not  made  to  act 
more  efficiently.     But  all  these  effects  are  produced 
more  certainly  and  more  promptly  by  mountain- 
climbing  than  in  any  other    way.     After    several 
weeks  spent  in  mountain  excursions,  the  condition 
of  the  patient  is  radically  changed  for  the  better. 
There  is  an  elasticity  of  the  mental  processes  in 
place  of  the  former  hebetude  ;  will,  thought,  and 
impulse  seem  to  move  on  wings  ;  the  formerly  dull 
senses    are    sharpened ;    the    formerly    half-closed 
eyes  sparkle,  and  the  flabby  cheeks  become  full  and 
rosy ;  the  once  prominent  abdomen  is  reduced  to 
more  seemly  dimensions,  notwithstanding  that  food 
and  drink  are  taken  with  greater  relish ;  while  the 
chest  is  expanded.     These  changes,  it  is  true,  are 
not  without  their  inconveniences  to  the  patient  as 
regards    his    apparel,   for  his    unmentionables    are 
found  to  have  become  much  too  large  around  the 
waist,  while  his  coat,  collar  and  shirt  have  grown 
too  small.     He  who  was  before  so  heavy  and  dull 
now  feels  as  elastic  and  sprightly  as  if  the  burden  of 
earthly  existence  had  been  lifted  from  his  shoulders, 
and,  almost  as  in  his  childhood  days,  goes  running 
and  springing  along,  covering  a  distance  of  ten  or 
twelve  miles  a  day.     He  has  no  longer  the  shape  of 


100 


a  discontented  and  surly  creature,  a  parody  on  man- 
kind, but  fits  better  in  the  ranks  among  other  strong 
and  happy  beings  :  he  is  possessed  of  a  new  spirit, 
his  pulse  beats  more  strongly,  and  the  tone  of  his 
entire  circulatory  system  is  better." 

The  value  of  such  exercise  in  the  cure  of  various 
diseases  is  more  and  more  recognized  every  day. 
Systematic  exercise  of  this  nature  is  now  practiced 
at  several  institutions  in  Germany  having  large 
tracts  of  mountainous  land  about  them  laid  out  with 
graded  walks  for  the  cure  of  heart  troubles,  of  obesity, 
and  even  of  consumption.  These  are  intended,  of 
course,  for  those  who  are  allowed  a  certain  amount 
of  exercise  only.  For  others,  suffering  from  various 
forms  of  chronic  disease,  such  as  rheumatism,  gout, 
dyspepsia,  anaemia,  and  other  circulatory  disturb- 
ances, mountain  excursions  are  organized  under  the 
supervision  of  a  physician,  the  walking  and  climbing 
being  systematically  undertaken,  and  the  progress 
and  effect  of  the  exercise  carefully  watched. 


VARIATIONS  IN    INDIVIDUAL  ABILITY. 

Some  persons  possess  very  little  constitutional 
power  of  resistance,  a  very  slight  injurious  influence 
being  sufficient  to  cause  prolonged  and  severe  disease. 
Others,  on  the  contrary,  are  able  to  withstand  many 


101 


sinister  influences,  and,  even  when  their  health  is  in 
some  degree  impaired,  recover  very  quickly.  It  is 
well  to  know  one's  own  power  of  resistance  to  such 
influences,  and  to  act  accordingly. 

As  to  abilities;  these  are  always  limited  in  a  cer- 
tain sense,  because  a  decided  inclination  is  usually 
shown  in  but  one  direction  and  is  then  increased  by 
constant  study  and  practice.  In  Greece,  for  instance, 
those  who  practiced  running  were  incredibly  swift, 
while  of  the  old  Teutons  it  is  reported  that  they  were 
able  to  jump  over  five  or  six  horses  standing  abreast. 
There  are  people  who  can  swim  many  miles  at  a 
stretch.  The  cowboys  on  our  western  plains,  the 
Csikos  in  Hungary,  the  Gauchos  in  the  Argentine 
Kepublic,  and  the  Cossacks  in  Russia  excel  in  horse- 
back exercise.  Contortionists,  snakemen,  india-rub- 
ber men,  and  kickers  are  able  to  turn  and  twist  their 
bodies  and  limbs  in  an  almost  inconceivable  manner, 
the  result  of  long  and  hard  practice.  Again,  there  are 
laborers  in  Bulgaria,  Albania,  and  Armenia  who  can 
carry  as  much  as  four  hundred  or  five  hundred 
pounds  up  the  mountains.  The  Roman  emperor 
Maximinian  was  so  strong  that  he  could  successfully 
oppose  the  strength  of  two  horses  in  drawing  a  load. 
There  are  mountaineers,  who  on  level  ground  could 
not  beat  a  champion  runner,  but  who  on  a  mountain 
ascent  would  without  effort  leave  the  same  adversary 
far  behind. 


102 


There  are  persons,  mostly  ladies,  who  are  able  to 
smell  or  taste  things  which  no  one  else  can  appre- 
ciate. Very  remarkable  in  this  respect  are  the  so- 
called  pathfinders  in  the  Argentine  Republic,  who, 
by  their  acute  sense  of  smell,  are  able  to  track  peo- 
ple, as  bloodhounds  do,  for  a  great  distance.  The 
fingers  of  some  Oriental  ladies  possess  a  sense  of 
touch  so  highly  educated  that  they  can  judge  the 
weight,  even  of  small  gems,  as  accurately  as  the 
finest  scales. 

The  Maoris,  the  natives  of  New  Zealand,  have 
been  taught  through  generations  to  use  their  feet  as 
hands,  and  can  perform  many  a  feat  with  them.  So 
also,  cripples  born  without  arms  have  been  known 
to  achieve  great  proficiency  in  writing,  painting, 
embroidering,  rowing,  and  other  exercises  performed 
with  their  feet. 

It  is  a  well  known  fact  that  some  people,  although 
uneducated  and  in  most  things  extremely  stupid, 
possess  the  power  of  calculating  with  incredible  speed 
and  accuracy.  On  the  other  hand  there  have  been 
polyhistors,  men,  that  is,  whose  manysidedness  is 
astonishing,  like  Aristotle,  Newton,  Goethe,  Hum- 
boldt, Arago,  and  Gauss.  But  as  a  rule  great  men 
excel  only  in  a  particular  branch  of  science  or  art. 


HYGIENE  OF  AGE  AND  OCCUPATION. 


hygie:n'e  of  infancy. 

To  a  great  extent  the  condition  of  a  child  depends 
upon  the  surroundings  among  which  its  parents  live. 
In  large  cities  the  majority  of  infants  born  are 
doomed  to  die  young,  boys  more  especially  so  than 
girls.  This  is  due  in  but  a  very  small  degree  to  the 
delicate  condition  of  the  infants.  Far  more  fre- 
quently the  parents  are  at  fault,  although  they  do 
not  perhaps  sin  knowingly  and  in  many  cases  can- 
not alter  the  circumstances,  even  if  they  wish  to  do 
so.  But  even  when  extreme  poverty  and  ignorance 
are  excluded,  there  are  a  great  many  rules  to  be 
followed  which  even  well-to-do  people  do  not  suffi- 
ciently heed. 

It  is  not  well  to  accustom  a  baby  to  too  much 
rocking  or  being  carried  about  indoors.  Vomiting 
may  result  from  this  practice  after  a  meal.  The 
child  should  remain  quietly  in  bed,  and  should  be 
taken  up  only  when  nursing  is  necessary,  or  a 
change  of  clothing  or  air.    Its  head  should  not  be 


104 


kept  very  warm.  If  the  child  perspires  much  about 
the  head,  a  pillow  stuffed  with  horsehair  should  be 
placed  beneath. 

It  is  a  bad  habit  to  give  the  child  a  sucking  bag. 
This  may  cause  sprew  and  even  graver  diseases  of 
the  alimentary  canal. 

The  best  nourishment  for  an  infant  is  its  mother's 
milk;  less  so  that  of  a  wet  nurse,  and  still  less  cow's 
milk.  Other  nutriments  than  milk  should  be 
avoided,  if  possible ;  milk  and  milk  only  is  required. 
A  healthy  mother  will  find  the  greatest  satisfaction 
in  nursing  her  own  child.  Even  if  her  milk  does  not 
flow  copiously  during  the  first  few  days,  she  should 
not  for  that  reason  abandon  nursing.  '^  Improper 
feeding  is  in  far  the  larger  number  of  instances  the 
true  cause  of  infant  mortality:  the  proper,  the  na- 
tural source  of  a  child's  nourishment  is  its  mother's 
breast."  Its  mother's  milk  is  drawn  directly  from 
her  breast  by  a  child,  while  "  artificial "  nutriments 
of  every  description  must  first  make  a  wide  and 
dangerous  circuit.  Think  only  through  how  many 
hands,  through  how  many  tubs  and  pails  cow's 
milk  must  pass  from  the  milking  to  the  child's  stom^ 
ach !  How  many  dangers  attend  that  passage ! 
Who  does  tho  milking  ?  Is  he  sick  or  healthy  ?  Are 
his  hands  clean  or  dirty  ?  Who  cleanses  all  the 
vessels  into  v/hich  the  milk  is  poured  and  repoured  ? 
Of  all  the  falsifications  and  other  dangers  to  which 


105 


it  stands  exposed  by  the  way  we  will  say  nothing 
here.  The  poor  child,  with  its  delicate  organization, 
is  exposed  to  still  other  dangers.  Next  in  import- 
ance among  these  is  the  cow  herself  and  her  sur- 
roundings. Her  bedding,  her  fodder,  and  similar  con- 
siderations exercise  a  most  potent  influence  upon  the 
animal  herself  and  her  milk.  Then  too  external 
diseases  must  be  taken  into  consideration,  diseases 
of  the  skin,  crusts  upon  the  udder,  from  which 
especially  dirt  is  liable  to  drop  into  the  milk.  And 
even  when  the  milk  is  finally  safe  in  the  can  and 
has  passed  into  the  custody  of  the  milkman,  there  is 
still  the  danger  of  the  appearance  of  bacilli  which 
produce  putrefaction  and  fermentation.  But  the 
worst  danger  of  all  is  the  possibility  of  bacteria, 
germs  of  disease,  being  transferred  in  overwhelm- 
ing numbers  from  the  cow  herself  to  her  milk,  and 
from  her  milk  to  whoever  consumes  it. 

A  newborn  child  does  not  require  anything  dur- 
ing the  first  twenty-four  hours,  and  very  little  for 
the  next  day  or  two.  The  large  amount  of  sugar 
water  and  fennel  tea  given  to  infants  is  quite  unnec- 
essary, and  is  often  the  cause  of  flatulence.  With 
nursing  mothers  the  milk  appears  in  the  breasts 
upon  the  second  or  third  day  at  the  latest. 

The  child  must  not  be  kept  constantly  at  the 
breast  nor  placed  there  whenever  it  cries.  Such  a 
QOUrse  is  a-lniost  certain  to  disorder  its  digestion  by 


106 


denying  rest  to  the  digestive  organs,  and  the  child 
in  consequence  becomes  peevish  and  exacting.  In 
regard  to  the  frequency  of  Nursing,  Dr.  Jacobi  says, 
in  his  circular  written  for  the  New  York  Board  of 
Health  : 

*'  Overfeeding  does  more  harm  than  anything 
else.  Nurse  a  baby  of  a  month  or  two  every  two  or 
three  hours. 

*^  Nurse  a  baby  of  six  months  and  over  five  times 
in  twenty -four  hours,  and  no  more. 

*^  When  a  baby  gets  thirsty  in  the  meantime,  give 
it  without  fear  a  drink  of  water  or  barley-water.  No 
sugar.  In  hot  weather — but  in  the  hottest  days  only 
— mix  a  few  drops  of  whiskey  with  either  water  or 
food,  the  whiskey  not  to  exceed  a  teaspoonful  in 
twenty-four  hours." 

In  case  of  disease  or  weakness  in  the  mother,  the 
physician  should  decide  upon  the  propriety  of  her 
nursing  her  child.  If  he  thinks  best  that  she  should 
not  do  so,  a  Wet  Nurse  ought  to  be  procured.  This 
again  is  the  physician's  duty,  since  it  is  very  import- 
ant to  the  health  of  a  growing  child  that  its  nurse 
should  be  thoroughly  healthy.  The  diet  of  the  wet 
nurse  should  vary  but  little  from  that  to  which  she 
has  been  accustomed.  It  should  exclude  all  sub- 
stances of  difficult  digestive  qualities  or  of  slight 
nutritive  value.  A  moderate  excess,  and  yet  not  too 
great  a  preponderance,  of  albuminous  foods  is  desir- 


107 


able  in  order  to  promote  the  secretion  of  milk.  To 
the  same  end  cow's  milk,  oatmeal  gruel,  and  barley- 
water  are  useful  articles  of  diet,  partly  on  account 
of  the  fluids  they  contain.  Of  the  various  methods 
recommended  for  increasing  the  flow  of  milk  little 
that  is  favorable  can  be  said,  unless  it  be  of  the  judi- 
cious application  of  electricity. 

If  a  wet  nurse  is  employed,  her  child  should  be 
of  about  the  same  age  as  the  child  to  be  nursed. 
Both  she  and  her  child  must  be  closely  observed  and 
examined.  The  milk  changes  somewhat  according 
to  the  requirements  of  the  child,  and  the  nurse  should 
therefore  not  have  given  birth  to  her  own  child 
longer  than  six  or  eight  weeks  earlier  than  the  birth 
of  the  foster-child. 

If  circumstances  render  bottle-feeding  necessary, 
animal  milk  should  be  given  after  being  warmed 
and  made  to  resemble  human  milk  as  nearly  as  pos- 
sible by  the  addition  of  water,  milk-sugar,  and  table- 
salt.  It  may  also  be  mingled  with  either  barley- 
water  or  oatmeal  gruel. 

Jacobi  advises,  when  there  is  an  inclination  to 
diarrhoea,  to  use  barley-meal,  if  to  constipation,  oat- 
meal in  the  milk.  Milk  should  be  given  in  smaller 
quantity  or  wholly  discontinued  when  diarrhoea 
exists.  Raw  albumen,  with  or  without  a  few  drops 
of  cognac,  may  be  substituted  for  the  milk.  Ready- 
prepared  barley  flour  should  not  be  used,  especially 


108 


if  fine  and  white,  but  whole  meal  should  be  pro- 
cured and  ground  in  a  coffee  mill  as  fine  as  possible, 
in  order  that  it  may  be  cooked  more  easily  and  may 
be  rendered  more  nutritious.  '^  We  should  be  care- 
ful that  barley  gruel  is  strained  till  perfectly  clear, 
and  should  prepare  for  a  newborn  child  a  mixture  of 
one  part  of  boiled  milk  with  five  parts  of  barley 
gruel,  for  very  young  children  a  mixture  of  one  part 
of  milk  with  three  of  barley  gruel,  for  children  from 
two  to  five  months  old  a  mixture  of  one  part  of  milk 
and  two  of  barley  gruel,  and  for  older  children 
equal  parts  of  milk  and  gruel."  During  the  cooking 
a  little  salt  should  be  added,  and  afterwards  a  mor- 
sel of  white  sugar.  The  mixture  may  then  be  given 
lukewarm.  Oatmeal  gruel  must  be  cooked  and 
strained  in  the  same  way. 

"In  hot  summer  weather,"  says  Jacobi,  "the 
food  should  be  tested  with  a  strip  of  blue  litmus- 
paper.  If  the  paper  turns  red,  the  food  should  be 
renewed  or  a  little  bicarbonate  of  soda  mixed  with 
it.  A  child  of  six  months  may  have  a  little  meat 
broth  or  meat  tea  once  a  day,  clear  or  mixed  with 
its  other  food ;  a  child  of  ten  or  twelve  months  may 
be  allowed  a  crust  of  bread  or  a  morsel  of  half  done 
beef  to  suck,  or  half  an  egg  raw  or  soft-boiled.  No 
sweets  must  be  allowed,  and  nothing  not  mentioned 
in  these  directions  upon  any  account,  unless  sanc- 
tioned by  the  physician." 


109 


Dr.  Babcock,  of  St.  Louis,  says  "After  a  pro- 
longed and  careful  study  of  this  question  from  the 
stand-point  of  practice,  we  have  come  to  the  conclu- 
sion that  the  milk-and-cream  food  advocated  by  Dr. 
Arthur  Meigs,  of  Philadelphia,  Dr.  Joseph  Winters, 
of  New  York,  and  others,  is,  beyond  any  compari- 
son, the  best  artificial  food  for  infants,"  especially  in 
the  colder  season.  **Its  composition  for  an  infant 
of  six  months  is  as  follows  :  Milk,  3  parts ;  cream,  1 
part ;  lime-water,  1  part ;  boiled  water,  2  parts  ;  and 
sugar  of  milk,  1  part.  Solution  of  bicarbonate  of 
soda,  three  grains  to  the  ounce,  may  be  substituted 
for  the  lime-water  in  case  the  baby  is  constipated. 
This  food  meets  the  general  indication  of  resem- 
blance to  mother's  milk  in  specific  gravity,  richness 
in  fats,  alkalinity,  and  sweetness.  Inasmuch  as 
milk-sugar  is  rather  expensive,  one -fourth  the 
amount  of  cane-sugar  may  be  substituted  in  cases 
of  healthy  children  over  six  months  of  age.  But 
with  all  children  younger  than  that,  and  with  older 
ones  who  are  suffering  from  bowel  or  stomach  dis- 
turbances, the  milk-sugar  will  be  found  decidedly 
preferable." 

Jacobi  also  recommends  the  addition  of  a  little 
gelatine  or  gum  arable  to  the  milk  given  to  children, 
saying  "they  not  only  fulfil  the  indication  of  clari- 
fying the  milk  and  separating  its  particles,  an  im- 
portant consideration  in  itself,  but  they  also  serve 


no 


as  direct  means  of  nutrition.  They  farther  fulfil  the 
conditions,  for  a  popular  and  practical  food,  of  being 
simple  in  themselves,  found  in  every  grocery,  free 
from  all  humbuggery,  cheap,  and  easy  to  prepare. 
Simple  boiling  in  water  is  all  that  is  required  :  for 
the  powdered  gum  solution  alone  is  sufficient." 

In  order  to  replace  the  deficient  fat  of  thin  milk, 
the  same  writer  recommends  to  ''add  a  spoonful  of 
fine  white  flour  to  a  quart  of  buttermilk,  cook  the 
mixture  for  a  few  minutes  till  a  thin  broth  results, 
and  finally  to  fiavor  with  ten  or  a  dozen  grains  of 
sugar.  When  diarrhoea  exists,  rice  should  be  used 
instead  of  flour."  In  case  of  any  sickness  Dr.  Jacobi 
would  interdict  milk  altogether  as  an  infant  food. 

The  Bottle  and  its  appurtenances  must  be  kept 
scrupulously  clean,  and  it  is  well  to  have  more  than 
one  bottle  in  use,  so  that  the  most  thorough  cleansing 
may  be  ensured  by  keeping  them  most  of  the  time 
in  water.  Never  pour  more  than  the  quantity  of 
milk  used  at  one  feeding  into  the  bottle,  and,  if  not 
all  is  used,  throw  the  remainder  away.  In  summer 
the  milk  must  be  kept  on  ice  and  warmed  before 
using. 

In  order  to  keep  milk  wholly  free  from  bacteria 
it  must  be  completely  removed  from  all  possibility 
of  contact  with  the  air  and  with  other  substances — a 
matter  very  difficult  of  accomplishment.  But  we 
may  proceed  about  it  as  follows  : — Make  a  frame  of 


Ill 


wire  or  wood  large  enough  to  hold  as  many  bottles 
of  milk  as  the  child  drinks  in  a  day  ;  that  should  be 
some  seven  or  eight  half  pint  flasks.  Place  this 
frame  in  a  vessel  of  cold  water,  the  water  not  to  rise 
above  the  middle  of  the  flasks,  and  bring  the  water 
to  the  boiling  point.  After  twenty  minutes  boiling 
stop  the  flasks  of  milk  with  rubber  stoppers,  which 
can  be  gotten  in  any  drug-store,  and  remove  them 
from  the  water.  Whenever  now  the  child  is  to 
drink,  draw  a  stopper  out  cautiously  and  slip  the 
nursing-tip  over  the  aperture.  Instead  of  preparing 
the  milk  eight  or  ten  times  a  day  and  continually 
warming  it  and  pouring  it  from  one  vessel  into 
another,  the  food  is  prepared  only  once  a  day 
and  is  kept  at  hand  ready  for  use.  Before  being 
emptied  the  bottle  need,  at  the  utmost,  only  be 
placed  a  few  minutes  in  warm  water.  By  this 
means  it  is  possible  also  to  carry  children  a  long 
distance  from  home,  taking  the  necessary  supply 
of  food  along. 

Ass's  milk  resembles  human  milk  more  closely 
than  that  of  any  other  animal.  !N"ext  in  order  stands 
cow's  milk,  which  is  almost  exclusively  used.  It 
should  be  diluted  at  first  with  an  equal  quantity  of 
water  or  gruel,  later  with  one  part  to  two  of  milk, 
and  finally  with  still  less.  When  about  eight  months 
of  age  a  child  ceases  to  require  the  addition  of  water 
to  cow's  milk,  although  gruel  may  still  be  added. 


11^ 


Sweet  whey  is  the  best  food  to  give  the  newborn 
during  the  first  two  or  three  days  of  its  life,  the 
gentle  laxative  action  of  whey  imitating  that  of  col- 
ostrum in  the  mother's  first  milk,  and  readily  evacu- 
ating the  earliest  tough,  dark-greenish  passages. 

Only  strong  and  healthy  mothers,  such  as  are  not 
unfavorably  affected  by  nursing,  should  be  allowed 
to  nurse  their  children,  and  these  should  constantly 
bear  in  mind  the  fact  that  in  so  doing  they  are 
directly  responsible  for  the  health  of  their  children. 
They  should  avoid  unsuitable  articles  of  diet,  ex- 
posure to  wet  or  cold,  great  exertion  of  any  sort,  loss 
of  sleep,  and  mental  excitement.  They  should  be 
especially  careful  to  improve  the  quality  of  their 
milk  by  proper,  nutritious,  and  easily  digestible 
foods,  partly  animal  and  partly  vegetable.  They 
must  also  breathe  pure  air,  must  take  a  moderate 
amount  of  exercise  every  day,  and  must  set  apart 
sufficient  time  for  sleeping  and  the  absolute  mental 
rest  which  accompanies  it.  All  passions,  even  con- 
jugal inclinations,  should  be  avoided,  or  at  least  only 
very  moderately  indulged  in.  If  some  unavoidable 
excitement  is  experienced,  such  as  fright,  great  joy, 
or  grief,  the  infant  should  not  be  nursed  for  some 
hours  afterwards,  and  it  may  even  be  found  advis- 
able to  pump  the  breasts  before  nursing.  The  breasts 
should  be  kept  tolerably  warm,  and  should  not  be 
pressed  by  tight  clothing  but  only  loosely  covered. 


113 


Neither  the  mother  nor  the  nurse  should  take  the 
child  into  her  own  bed.  Many  an  infant  has  been 
smothered  in  this  manner.  The  air  in  the  bedroom 
should  be  moderately  warm,  but  pure  and  dry.  Strong 
light  and  loud  sounds  should  be  guarded  against  and 
strict  cleanliness  observed  by  day  and  night. 

Weaning  should  take  place  when  the  child  is 
from  twelve  to  fifteen  months  old,  unless  some  other 
reason,  such  as  another  pregnancy,  necessitates  it 
earlier.  The  appearance  of  menstruation  is  no  rea- 
son to  cease  nursing.  The  first  teeth  make  their 
appearance  usually  about  the  eighth  month,  and 
when  the  first  year  of  life  is  completed  healthy  chil- 
dren have  enough  teeth  to  get  along  with.  Weakly 
children  and  those  teething  late  must  be  nursed 
longer  than  the  period  given  above.  Weaning  is 
best  accomplished  gradually,  and  may  last  several 
weeks.  A  healthy  season  should  be  selected,  and 
one  in  which  the  child  can  be  taken  out  of  doors. 

The  mother  should  restrict  her  diet  somewhat, 
and  the  child  should  be  put  to  the  breast  only  half  as 
often  as  before.  Other  liquid  food,  cow's  milk,  meat 
broth,  eggs,  should  be  substituted.  At  the  last  the 
breast  should  be  given  once  a  day  only;  and,  when 
the  day  fixed  upon  has  arrived,  the  child  should  be 
nursed  in  the  morning  for  the  last  time,  after  which 
the  mother  or  nurse  should  keep  out  of  sight  for  a 
day  or  two,  if  feasible,  so  that  remembrance  of  the 


114 


breast  may  become  obliterated.  If  this  is  not  found 
sufficient  for  the  purpose,  the  nipples  may  be  painted 
with  a  solution  of  aloes,  a  harmless  preparation 
whose  bitterness  will  disgust  the  child.  If  the  in- 
fant should  fall  sick  shortly  after  weaning,  nursing 
may  be  resumed  and  continued  for  some  time. 

A  warm  Bath,  or  at  least  an  ablution,  every  day 
is  essential  to  a  child's  welfare.  The  temperature  of 
the  water  should  at  first  be  100°  Fahrenheit,  and 
should  gradually  be  lowered  to  about  90° :  the  tem- 
perature of  the  room  should  not  fall  below  70^.  The 
child  should  be  immediately  taken  out  of  the  bath, 
if  its  lips  and  fingers  begin  to  look  blue  or  its  jaws 
to  quiver.  After  every  bath  it  must  be  rubbed  dry 
and  laid  in  a  warm  bed.  A  warm  bandage  is  neces- 
sary, partly  to  support  the  abdomen,  the  navel  more 
particularly,  but  also  to  protect  the  child  from  cold. 
Its  clothes  should  always  be  so  arranged  that  cold 
air  cannot  penetrate  beneath  them  and  strike  upon 
the  child's  body.  It  is  a  dangerous  practice  too  early 
in  life  to  allow  the  child  to  sit  erect  or  to  try  its 
powers  in  standing  or  walking.  It  is  said  to  be  pos- 
sible to  begin  education,  or  rather  mental  training, 
at  a  very  early  period.  Let  the  child  cry,  therefore, 
when  you  can  find  no  plausible  reason  for  its  crying: 
the  exercise  is  healthy  for  the  lungs,  and  the  baby 
should  not  be  taken  up  nor  humored  in  other  ways 
whenever  it  begins  to  cry. 


115 


HYGIENE    OF    CHILDHOOD. 

After  weaning,  a  child's  diet  should  consist  at 
first  principally  of  milk,  and  only  by  degrees  should 
custards  and  gruels  be  added  until  solid  food  is 
given.  Meat  broth  in  which  a  raw  egg  has  been 
beaten  up  may  be  followed  by  oatmeal  gruel,  barley 
water  mixed  with  milk,  later  on  by  rice,  sago,  or 
farina  cooked  in  milk,  and  at  last  by  finely  cut  meat 
and  bread  or  crackers.  "  The  child  must  learn  never 
to  drink  its  milk  rapidly.  The  daily  quantum  of 
meat,  preferably  beef,  lamb,  or  poultry,  may  be  in- 
creased to  three  or  four  ounces,  to  be  given  in  two 
meals."  Spiced  foods  or  drinks,  coffee,  tea,  wine, 
beer,  and  sharp^  condiments,  are  to  be  avoided. 
When  recovering  from  exhausting  disease  rich 
wines  or  malt  extracts  are  allowable,  but  they  are 
to  be  prescribed  only  by  the  physician.  Pota.toes, 
in  whatever  form,  are  to  be  given  very  sparingly, 
and  so  too  is  black  bread.  It  is  a  very  bad  practice 
for  parents  to  give  their  little  ones  a  portion  of 
everything  that  comes  upon  the  table.  It  is  much 
better  to  give  the  children  their  meals  before  din- 
ner or  supper  time,  and  not  to  let  them  sit  at  the 
table  at  all. 

Toward  the  end  of  the  third  or  at  the  beginning 
of  the  fourth  year  of  its  life  a  child  should  be  taught 


116 


to  accustom  itself  to  cold  air  and  to  somewhat  cooleiJ 
water.  It  is  not  well  however  to  force  the  harden- 
ing of  children  in  this  respect.  Many  children  have 
an  antipathy  to  cold,  and  often  it  affects  disas- 
trously the  brain  or  lungs. 

Sleep  is  absolutely  necessary  to  children  when 
growing  and  beginning  to  use  their  muscles.  They 
should  never  fail  to  take  several  hours'  sleep  in  the 
middle  of  each  day. 

The  child's  hands  should  be  kept  from  under  the 
cover,  and  care  should  be  taken  that  it  does  not  ac- 
quire the  habit  of  putting  them  beneath  its  clothing 
and  playing  with  its  parts.  It  should  be  trained  as 
early  as  possible  to  announce  its  needs  when  felt. 

Cleanliness  should  be  inculcated  in  every  respect, 
as  to  dresses  and  underwear,  eating  and  drinking, 
and  all  other  requirements.  But  we  must  not  be  too 
rigid  and  exacting  in  this  respect.  The  child's  play 
and  its  freedom  of  movement  in  the  open  air  should 
not  be  allowed  to  be  hampered.  This  brings  to  mind 
the  story  related  of  Emperor  Joseph  II.,  of  Austria 
who,  when  a  boy,  was  asked  by  his  governor  what 
present  he  would  most  like  upon  his  birthday.  '*  Only 
let  me  play  once  the  way  those  children  are  allowed 
to  play"  he  answered,  and  pointed  to  a  number  of 
children  digging  in  a  large  heap  of  sand. 

The  dresses  should  be  short  and  should  not  fit 
tightly,  the  head  and  neck  should  be  left  entirely 


117 


free,  and  only  against  the  sun,  cold,  and  wind  should 
protection  be  given.  The  toys  should  not  be  colored, 
for  poisonous  coloring  matters  might  reach  the 
child's  mouth  from  them. 

Mental  training  ought  continually  to  be  regarded, 
and  it  should  be  consistent,  dispassionate,  and  severe, 
but  at  the  same  time  loving  words  should  show  the 
child  that  all  is  meant  for  its  own  good.  A  great 
blessing,  especially  to  parents  who  have  little  time 
to  spare,  are  kindergartens  after  the  method  of 
Froebel.         ^ 


HYGIENE  OF  SCHOOLCHILDREN. 

During  their  school  years  children  require  an 
abundance  of  good,  substantial  food.  ISTo  coffee  or 
tea  is  necessary  :  milk  and  cocoa  are  much  more 
healthful.  Some  parents  are  accustomed  to  forbid 
the  use  of  salt,  of  dishes  which  contain  much  fat, 
and  the  free  consumption  of  drinking-water.  This 
must  not  be  overdone,  since  the  human  body  requires 
a  considerable  supply  of  both  salt  and  water. 

In  boarding-schools  and  other  institutions  the 
children  should  be  dressed  alike,  the  quality  'of  the 


118 


goods  as  well  as  the  cut  and  color  of  wearing  ap- 
parel l)eing  exactly  similar,  in  order  to  prevent  ill- 
feeling  upon  the  one  side  or  assumption  upon  the 
other.  Many  of  the  styles  worn  hy  children  at  pres- 
ent actually  encourage  the  passion  for  dress  and 
finery,  especially  in  girls,  and  show  that  parents  do 
not  love  their  children  as  they  should.  Mothers  with 
common  sense  always  strive  to  promote  a  taste  for 
simplicity,  which  alone  is  really  aristocratic,  and 
thereby  to  prevent  their  daughters  from  holding  as 
their  sole  object  in  life  the  ridiculous  and  unnatural 
passion  for  expensive  dress,  jewelry,  and  display, 
which  constitutes  the  sole  ambition  of  so  many 
women. 

Girls,  as  well  as  boys,  should  daily,  if  possible, 
take  some  exercise  in  the  open  air,  walking,  run- 
ning, jumping,  swimming,  skating,  dancing,  gym- 
nastics, or  calisthenics.  At  least  ten  hours  of  sleep 
should  be  allowed  after  a  day  so  spent. 

A  child  ought  never  to  be  overworked  by  private 
instruction  and  school  lessons  after  school  hours.  In 
school  a  child  should  not  be  allowed  to  sit  in  a  dis- 
torted position  nor  without  a  support  for  its  back. 
The  utmost  care  should  be  exercised  in  regard  to 
the  desk  a  child  is  to  sit  at  in  school.  Indeed,  this 
subject  is  so  important  that  parents  ought  never  to 
fail  of  having  their  child's  desk  approved  by  a  phy- 
sician.   Perhaps  the  best  plan  would  be  for  the  desk 


110 


to  be  purchased  by  the  parents  after  examination  by 
the  physician  ;  for,  as  every  age  and  size  demands 
its  appropriate  dress,  so  each  individual  requires 
that  tables  and  school-desks  be  fitted  to  the  special 
form  of  his  spinal  column. 

Curvature  of  the  spine  may  owe  its  origin  not 
only  to  malposition  at  school  desks,  but  also  to  long 
continuance  in  one  position,  by  which,  from  simple 
fatigue,  a  certain  set  of  muscles  becomes  weak  and 
relaxed  and  finally  gives  way.  First  the  elastic  discs 
yield,  and  later  the  chain  of  bones  of  which  the  spine 
is  composed.  Such  a  curve  is  easily  straightened  at 
first,  but  it  becomes  a  ^^  fixed  fact "  after  a  while. 

Regarding  the  school  life  of  children.  Dr.  Roosa 
writes  '^  We  see  their  little  forms  wasting,  their  soft 
bones  bending,  their  eye-balls  lengthening  and  thus 
producing  short-sightedness  from  too  continuous 
employment  in  the  school-room,  and  over  the  study- 
table  at  home,  but  our  advice  is  not  asked  until  the 
deplorable  consequences  are  painfully  evident. 
Even  then  the  great  anxiety  of  parent  and  teacher, 
an  anxiety  often  yielded  to  by  the  physician,  seems 
to  be,  not  to  get  and  keep  the  child  in  a  physiologi- 
cal condition,  but  to  enable  him  to  go  on,  without 
any  interruption  of  his  very  •  important  study  of 
books — ^the  incorrect  notion  being  held  that  education 
consists  wholly  in  the  study  of  printed  words.  We 
are  sent  for  when  the  defective  sewerage,  the  leak 


120 


in  the  waste-pipe,  the  over-crowding  and  insufficient 
ventilation  and  lighting  of  the  school-room,  the 
want  of  physical  exercise  and  food,  the  excessive 
employment  of  the  brain,  have  done  their  work, 
and  we  have  to  deal  with  a  febrile,  short-sighted, 
catarrhal,  and  puny  patient.  "We  are  expected  to 
cure  the  fever,  to  put  glasses  upon  the  eyes,  and  set 
the  poor  machine  at  work  again,  without  a  remon- 
strance against  the  system  that  has  produced  all 
this  misery.  We  have  not  until  very  lately  been 
asked  to  look  after  the  public  and  private  school- 
houses,  to  see  how  the  seats  are  constructed,  or  the 
rooms  lighted  and  aired,  to  examine  into  the  drain- 
age of  the  college  grounds,  to  prescribe  the  diet  and 
the  proportionate  hours  of  study  and  exercise.  Per- 
haps we  should  not  all  know  how  to  perform  these 
duties  well,  were  they  required  of  us,  but  they  will 
certainly  be  among  the  functions  of  the  coming 
medical  man." 

The  air  of  the  room  should  neither  be  allowed  to 
become  impure,  nor  to  be  too  hot  or  too  cold.  The 
clothing  worn  should  be  very  loose  about  the  limbs 
and  body.  In  winter  all  outer  clothing  must  be  of 
wool.  But  no  winter  is  so  severe  as  to  excuse  the 
use  of  heavy  woolen  hoods  and  fur  caps.  It  is  im- 
portant that  clothing  should  fit  well  both  upon  small 
and  larger  childreii, 


121 


HYGIENE  OF  YOUTH. 

The  phases  of  development  at  the  age  of  puberty 
demand  especial  attention.  Sex  begins  now  to  mani- 
fest itself,  and  must  be  taken  into  consideration  in 
all  its  aspects  and  in  every  connection.  Growth  and 
a  certain  tendency  to  rounded  forms  advance  very 
rapidly  in  female  children,  while  the  various  organs 
develop  gradually  to  their  proper  form  and  size.  In 
young  men  the  chest  and  the  muscular  system  de- 
velop most  largely,  in  young  women  the  hips. 

It  has  been  observed  that  girls  who  are  late  in 
beginning  menstruation  retain  their  youth  and  health 
longer  in  later  life  and  even  as  a  rule  live  longer. 
These  blessings  may  be  secured  by  introducing  girls 
only  as  late  as  possible  into  society  and  by  treating 
them  as  children  as  long  as  may  be.  It  is  well  for  a 
mother  to  prepare  her  daughters  for  the  symptoms 
of  puberty.  No  steps  should  be  taken  however  to 
accelerate  its  appearance. 

The  diet  at  this  period  should  be  simple  and 
unirritating,  but  very  substantial,  easily  digestible, 
and  ought  to  contain  a  sufficient  amount  of  fat  as 
well  as  a  proper  quantity  of  salt. 

The  education  of  both  mind  and  body  in  a  grow- 
ing girl  should  have  as  its  principal  object  her  des- 
tination as  a  wife  and  mother.     It  w^^i^^  be  of  great 


122 


advantage  to  every  young  woman  and  to  her  future 
offspring,  if  she  would  visit  orphan  asylums,  nur- 
series, and  kindergartens,  and  there  make  practical 
studies  in  education. 

A  cultured  lady  should  be  able  to  understand  the 
usual  topics  of  conversation  in  society,  the  various 
aspects  of  life,  and  the  interests  of  humankind  in 
general.  She  may  not  perhaps  be  able  to  advance 
a  decided  opinion,  but  she  should  be  capable  of  fol- 
lowing and  inclined  to  follow  conversations  upon 
subjects  of  general  interest,  and  to  participate,  if 
needful.  She  ought  at  this  period,  therefore,  to  be 
furnished  a  good  general  knowledge  of  the  tendency 
of  human  endeavors  and  of  their  practical  results, 
of  the  progress  made  in  the  various  branches  of  art, 
science  and  morals,  and  of  the  marvelous  discoveries 
and  wonderful  inventions  of  the  human  mind. 


HYGIENE  OF  ADULT  LIFE. 

When  fully  developed,  the  system  at  length  comes 
to  a  standstill,  so  to  speak.  It  shows  however  a 
decided  staying  power.  An  adult  man  or  woman  is 
capable  of  enduring  exertions  and  privations  for 


12'6 


a  time  without  great  detriment ;  but,  if  these  are 
constantly  experienced,  they  show  their  effects  by 
causing  premature  old  age. 

Although  we  might  suppose  that  middle-aged 
persons  are  the  most  sober  and  sensible,  many  of 
the  simplest  rules  of  hygiene  are  continually  sinned 
against  by  them.  Protracted  mental  and  bodily 
work  without  sufficient  periods  of  rest,  unbridled 
passions  and  desires  of  various  kinds,  unnecessary 
dosing  with  all  kinds  of  medicine  upon  the  one  hand, 
and  disregard  of  real  symptoms  of  disease  upon  the 
other,  overfeeding  with  meat  and  other  rich  dishes, 
drinking  too  much  of  strong  liquors  instead  of  a 
sufficient  amount  of  water,  too  little  bodily  exercise 
with  too  much  ease  and  leisure — these  are  examples 
of  the  incorrect  methods  of  living  but  too  prevalent 
during  middle  life. 


HYGIENE  OF  OLD  AGE. 

Since  sexual  life  becomes  extinct  with  advancing 
age,  men  and  women  do  not  require  separate  con- 
sideration :  the  rules  of  life  they  find  it  necessary  tq 
conform  to  apply  to  both  sexes, 


124 


In  order  to  attain  to  advanced  age  disease  must 
be  avoided  in  early  life.  As  a  rule  those  who  have 
lived  one  hundred  years  or  more  have  rarely  been 
sick  during  the  earlier  periods  of  their  lives.  From 
this  it  will  be  seen  how  advantageous  it  is  to  be 
moderate  and  to  live  regularly  at  all  times.  In  say- 
ing this  we  have  reference  to  eating  as  well  as  to 
drinking,  to  conjugal  desires  as  well  as  to  mental 
and  bodily  work.  Overwork  is  always  hurtful  and 
foolish,  especially  when  it  is  permitted  simply  for 
the  sake  of  money  getting.  It  is  in  the  middle  walks 
of  life  that  we  find  the  larger  proportion  of  men  who 
are  sound  in  body  and  mind ;  for  here  all  have  suffi- 
cient wealth  to  enable  them  to  lead  healthful  and 
agreeable  lives,  full  of  rational  and  instructive  pleas- 
ures. Anything  that  tends  to  exceed  moderation  is 
inevitably  injurious.  Great  wealth  always  leads  to 
great  temptations,  and  to  enjoyments  which  are 
hurtful  and  destructive  in  their  tendencies.  The 
glitter  and  the  vainglory  which  it  fosters  are  as  inju- 
rious to  man  as  are  the  lanterns  of  high  light-houses 
to  wandering  birds  :  we  run  our  heads  against  them 
till  we  are  sorely  bruised  and  battered.  It  is  a  spec- 
tacle both  tragical  and  comical  to  see  rich  men  toil 
and  moil  for  greater  wealth  until  loss  of  health  de- 
prives them  of  the  possibility  of  enjoying  their  gain. 
Even  when  sickness  comes  and  death  threatens 
many  refuse  to  retire  from  the  cares  of  business  and 


125 


to  live  at  ease.    The  prevalent  cause  of  premature 
old  age  to-day  is  waste  of  vital  energy,  in  sexual 
desires  especially,  but  quite  as  much  in  overwork,  ' 
in  late  hours  of  work  and  enjoyment,  in  want  of 
proper  food  and  rest,  and  in  the  immoderate  drink- . 
ing  of  alcoholic  beverages. 

Old  age  brings  varied  troubles — catarrh  of  the 
lungs  with   the    attendant  cough,   catarrh  of    the 
stomach  and  bowels  with  loss  of  appetite  and  diar- 
rhoea, apoplectic  attacks  from  the  rupture  of  blood- 
vessels in  the  brain  after  age  has  hardened  them, 
ursemic  blood  poisoning  from  kidney  troubles,  senile 
gangrene  attacking  -the  extremities.     One  point  to 
be  kept  always  in  view  in  caring  for  aged  people  is 
this,  that  any  sudden  change  in  their  usual  mode  of 
life  must  be  avoided.     The  idea  that  hardening  and 
strengthening  is  good  for  them  is  wrong  :  on  the 
contrary  these  are  actually  injurious.      Old  people 
should  be  content  with  the  modicum  of  vital  energy 
and  health  they  have  retained   after  middle  life. 
They  must  accustom  themselves  to  their  enfeebled - 
condition,  and  must  not  try  to  increase  their  vital 
powers,  but  rather  to  retain  them  and  to  utilize- 
them   most   economically.     Muscular  exercise   and 
strenuous  mental  effort  are  as  injurious  as  strong 
excitements,  and  of  the  latter  the  most  injurious  are 
those  of  a  disagreeable  and  those  of  a  sensual  na- 
ture.   Old   people    do  well   to  associate  with   the 


126 

young  and  with  children ;  they  should  seek  society 
and  diversions  of  a  hilarious  nature.  Their  food 
should  be  nutritious,  but  simple  and  easily  digested  : 
it  ought  to  be  spiced  with  some  of  the  milder  condi- 
ments :  it  should  consist  of  broth,  beef -tea,  eggs, 
jellies,  oysters,  good  hash  of  fresh  meat,  juicy  roasts 
(game  and  poultry  preferably),  and  such  beverages 
as  cocoa,  milk,  and  coffee  with  cream  or  with  an 
egg  beaten  up  in  it.  A  glass  of  good  rich  wine  may 
be  taken  with  every  meal. 

Old  people  frequently  suffer  after  a  tolerably  full 
meal  from  some  gastric  disturbance.  They  should 
therefore  eat  but  little  at  a  time,  should  rather  eat 
oftener  than  others,  and  should  shun  everything 
hard,  tough,  or  fibrous.  Many  die  at  the  threshold 
of  old  age,  much  earlier  than  would  seem  necessary, 
simply  because  they  do  not  restrict  their  diet,  and 
because  in  consequence  their  circulatory  and  other 
organs  are  overburdened  with  work  from  the  addi- 
tion of  superfluous  material  to  the  blood. 

The  clothing  of  old  people  should  be  warmer 
than  that  of  younger  persons,  since  their  bodies 
produce  less  heat,  and,  like  children,  they  thrive 
better  in  warmth.  During  cold  weather  more  old 
people  die  than  during  the  heated  season,  and  those 
not  adequately  clothed  more  readily  succumb  than 
those  who  are  warmly  dressed.  Warm  baths  and 
ablutions  followed  by  gentle  friction  are  very  neces- 


w 


Sary  on  account  of  the  diminished  action  of  the 
skin. 

Old  people  often  suffer  from  wakefulness.  In 
order  to  induce  sleep  their  bedrooms  should  be  quiet, 
spacious,  airy,  and  moderately  warm.  They  should 
lie  with  heads  considerably  elevated.  They  must  be 
warned  very  decidedly  against  heavy  meals  at 
night,  excitement  before  retiring,  and  anything  else 
likely  to  induce  apoplexy. 


HEALTH  AND  MORALS. 

To  the  attainment  and  preservation  of  beauty 
not  only  are  thorough  and  rational  hygiene  of  the 
skin  and  hair  requisite,  aided  by  bodily  exercise, 
but,  aside  from  these  external  influences,  the  im^ 
press  of  the  mental  and  moral  atmosphere  in  which 
the  individual  lives,  the  kind  of  work  he  is  engaged 
in,  his  virtuousness  or  voluptuousness,  all  these  and 
other  influences  stamp  themselves  upon  his  features 
and  assist  in  making  him  appear  noble  and  beautiful 
or  low  and  ugly,  as  the  case  may  be.  Excesses,  pas- 
sions, and  unnatural  habits  can,  as  a  rule,  be  read  in 
the  features,  and  tend  to  make  them  appear  uglier 


128 


and  older.  Every  man  is  responsible  for  his  own 
Irreatment  at  the  hands  of  his  fellows.  He  who  deals 
hardly  and  proudly  with  other  men  will  be  sure  to 
receive  no  kinder  usage  in  return.  He  who  is  in- 
dulgent and  liberal  to  his  subordinates  will  be  loved 
by  them  and  will  receive  affectionate  service  from 
them;  while  he  who  is  indifferent  to  the  welfare  of 
dependents  embitters  his  own  life  far  more  than  he 
supposes.  A  cheerful  mind  contributes  much  to 
tranquillity  of  life.  So  long  as  we  are  healthy  and 
happy,  we  need  have  little  dread  of  epidemics,  even 
of  typhus  and  cholera.  The  general  character  of  an 
individual  is  dependent  upon  physical  conditions  just 
as  much  as  it  is  upon  his  moral  surroundings,  upon 
the  early  impressions  he  receives,  or  upon  the  various 
influences  for  good  or  temptations  to  evil  which  he 
meets  with.  A  mind  free  from  low  egotism  and  full 
of  noble  impulses  is  one  of  the  best  guarantees  of 
bodily  health.  People  who  carry  clear  consciences 
sleep  soundly  and  digest  well  as  a  rule.  The  favor- 
able influence  of  a  quiet,  self-contained  mind  is  a 
potent  factor  in  the  restoration  of  health,  for  it  is  a 
well-known  fact  that  care  and  trouble,  particularly 
when  actual  want  is  threatening,  not  only  depress 
the  mind,  but  sometimes  interfere  with  convales- 
cence, and  may  even  be  the  indirect  cause  of  such 
diseases  as  cancer,  diabetes,  heart  disease,  consump- 
tion, and,  most  dreaded  of  all,  of  melancholia,  gen- 


129 


eral  paresis,  and  other  forms  of  insanity.  How 
rapidly  emotions  may  take  effect  we  see  from  the 
closeness  with  which  they  may  be  followed  by  severe 
diarrhoea.  In  a  certain  portion  of  the  East  Indies 
it  is  customary  to  place  rice  in  the  mouths  of  those 
suspected  of  any  theft.  He  in  whose  mouth  the  rice 
remains  most  dry  is  considered  the  thief,  experience 
having  shown  that  emotion  reduces  the  discharge  of 
saUva. 

The  best  way  of  securing  mental  quietude  is  to 
possess  a  clear  conscience.  The  feeling  that  we  have 
always  done  our  duty  so  far  as  lay  in  our  power  is  in 
this  respect  of  the  highest  importance.  Since  * '  charity 
begins  at  home,'*  we  should  first  of  all  fulfil  our  duty 
to  our  own  family.  It  is  not  necessary  that  a  hus- 
band and  father  should  bestow  upon  his  wife  and 
children  all  the  luxuries  wealth  affords,  but  it  is  of 
great  importance  to  remember  that  a  time  may 
come  when  he  can  no  longer  provide  for  them ;  and 
if  he  should  be  taken  away  from  them  earlier  than 
he  expected,  he  will  take  satisfaction  in  knowing 
that  "the  wolf  cannot  approach  the  door."  A  life- 
insurance  pohcy  for  a  good  sum  issued  by  a  com- 
pany of  high  standing  is  the  best  means  to  this  end, 
and  the  sin  of  such  an  omission  should  not  be  al- 
lowed to  embitter  the  last  moments.  When  in  pos- 
session of  such  a  policy,  death  will  appear  less 
dreadful,  grave  diseases  will  be  more  amenable  to 


130 


medical  treatment,  and  the  probability  of  early  con- 
valescence will  be  increased. 

In  the  foregoing  passage  we  have  advocated  life 
insurance  as  a  provision  against  the  time  of  death. 
But  life  insurance  companies  too,  it  may  not  be  out 
of  place  for  us  to  say  here,  owe  a  duty  to  their  pa- 
trons, the  discharge  of  which  is  conducive  to  the 
equanimity  of  the  individual  both  in  health  and  dis- 
ease. Quite  as  much  for  their  own  protection  as  in 
the  interest  of  their  patrons  they  should  do  their 
utmost  to  promote  the  sanitary  well-being  of  policy- 
holders, by  using  their  great  power  and  influence, 
and  even  by  direct  efforts,  to  bring  sanitary  meas- 
ures to  adoption  everywhere  and  in  every  possible 
respect.  Even  if  the  benefit  of  such  a  policy  was 
confined  to  their  own  patrons,  a  very  grateful  field 
of  labor  would  lie  open  to  them.  But  the  effect  of 
their  endeavors  could  not  be  so  limited  in  most  in- 
stances. Nor  would  it  be  well,  were  such  a  limita- 
tion possible.  For  a  partial  enforcement  of  sanitary 
laws  is  not  sufficient  to  prevent  the  occurence  of  an 
epidemic  or  even  to  limit  its  spread,  and  conse- 
quently the  insurance  companies  and  their  patrons 
could  not  by  restricted  precautions  escape  being 
affected. 


131 


MARRIAGE. 

Matrimony  exercises  a  very  favorable  influence 
upon  the  duration  of  life,  probably  on  account  of  the 
regular  and  systematic  methods  of  living  induced, 
and  the  consequent  protection  against  disease.  When 
attention  is  paid  to  the  laws  of  heredity,  marriage 
is  capable  of  serving  for  the  physical  and  psychical 
improvement  of  the  human  race.  The  highest  form 
of  matrimonial  selection  is  the  ^^  psychical  selection" 
of  Haeckel,  in  accordance  with  which  the  spiritual 
and  moral  preferences  of  one  sex  are  aroused  in  re- 
sponse to  those  of  the  other. 

No  less  regard  must  be  paid  to  the  condition  of 
health  of  the  contracting  individuals  and  of  their 
families,  for  we  know  that  certain  diseases,  insanity, 
cretinism,  epilepsy,  consumption,  and  others,  are 
frequently  inherited.  Intemperance  in  the  parent 
not  infrequently  precedes  mental  disease  in  the  off- 
spring. Most  lamentable  is  the  result  when  a  disease 
exists  in  both  families.  The  feeble  and  diseased  who 
renounce  marriage  in  obedience  to  the  dictates  of 
reason,  especially  those  whose  hearts  warm  toward 
humanity  and  who  know  how  to  employ  their  powers 
in  some  useful  activity,  not  only  act  in  obedience  to 
higher  motives,  but  also  secure  greater  happiness  to 
themselves,  than  if  they  became  the  parents  of  a 


13^ 


sickly  and  miserable  progeny.  If  such  individuals 
must  marry,  it  is  more  humane  and  more  desirable 
for  the  race,  that  a  union  should  be  entered  into 
between  two  unhealthy  persons  than  between  one 
who  is  diseased  and  one  who  is  sound,  for  in  the 
former  event  the  vitality  and  the  sufferings  of  the 
offspring  will  be  reduced  to  a  minimum  and  there 
will  be  less  danger  of  the  human  race  being  vitiated 
with  a  diseased  progeny. 

Among  many  species  of  animals  a  selection  of  the 
fittest  takes  place,  in  accordance  with  which  union 
is  the  reward  of  the  strongest  as  a  result  of  passion- 
ate struggles  between  rival  wooers.  Domestic  ani- 
mals too  are  often  submitted  to  a  similar  selection, 
in  making  which  their  owners  endeavor  to  couple 
the  most  serviceable  and  the  finest  animals.  But 
very  many  parents  act  less  sensibly.  It  should  at 
least  be  their  duty  to  institute  an  examination  into 
the  health  of  a  daughter's  suitor,  either  by  direct 
inquiry  upon  the  part  of  the  family  physician,  or 
indirectly  by  compelling  him  before  marriage  to 
effect  an  insurance  of  his  life  in  some  company  of 
acknowledged  standing.  Such  a  course  furnishes 
the  young  wife  not  only  a  guarantee  of  her  hus- 
band's health,  but  also  that  of  a  maintenance  pro- 
vided in  case  of  his  death. 

Surely  the  attraction  of  the  more  prominent  men- 
tal, moral,  and  physical  qualities  is  a  nobler  motive 


133 


than  that  of  wealth.  From  such  a  choice  alone 
springs  the  harmony  of  an  unsullied  happiness,  and 
so  only  may  two  beings  be  bound  together,  soul  and 
body,  in  a  pure  and  affectionate  unity  of  sympathies. 
What  we  say  is  not  mere  sentiment,  but  is  intended 
to  be  literally  understood  ;  for  gradually  the  quali- 
ties of  a  husband  become  impressed  upon  his  wife, 
and  not  infrequently  the  child  of  a  second  marriage 
bears  traces  of  its  father's  predecessor. 


HYGIENE  OF  THE  WORKSHOP. 

We  have  already  observed  that  the  muscular  sys- 
tem ought  not  to  be  overworked.  Not  only  is  this 
rule  applicable  to  the  system  as  a  whole,  but  indi- 
vidually to  each  of  its  parts,  notably  to  those  which 
are  especially  active  in  certain  occupations.  In 
order,  after  labor,  to  be  restored  to  its  normal  con- 
dition, the  body  must  have  sufficient  rest  and  proper 
food. 

Children  and  young  people  under  seventeen  years 
of  age  are  much  more  sensitive  than  adults  to  the 
injurious  influences  which  abound  in  shops  and  fac- 
tories,  ^0  one  should  begin  work  without  previously 


134 


consulting  a  physician,  and  the  first  step  in  every 
occupation  should  be  to  familiarize  one's  self  with 
the  different  substances  to  be  employed  and  with 
the  measures  possible  for  protection  from  dangerous 
influences. 

Whether  a  man  works  with  his  head  or  his  hands, 
he  should  be  conscious  of  the  fact  that  frequent 
changes  of  position  are  most  desirable.  It  is  exceed- 
ingly injurious  to  sit  or  stand  for  hours  at  a  time  in 
the  same  posture  with  the  body  bent  and  cramped 
together.  Handworkers  especially  should  be  careful 
to  keep  their  heads  and  bodies  upright  and  their 
chests  free  and  straight.  The  choice  of  a  proper  seat 
is  therefore  important.  The  angle  formed  by  the 
chest  with  the  table  or  workbench  should  approach 
as  nearly  a  right  angle  as  possible. 

Work  rooms  should  be  well  lighted  and  thor- 
oughly ventilated.  Before  the  latter  is  done  water 
should  be  sprinkled  or  damp  sawdust  strewn  about 
and  the  floor  swept  clean  in  order  to  prevent  dust 
and  other  noxious  particles  from  being  whirled  about 
in  the  shop.  Where  such  harmful  substances  are 
present  it  is  advisable  to  wear  a  respirator  or  a  mask 
filled  with  cotton  dipped  in  glycerine. 

Lead  and  its  preparations  are  substances  very 
mjurious  in  many  instances  to  workmen.  The  lead  is 
absorbed  into  the  system  by  inhalation  as  well  as  by 
being  swallowed  involuntarily  in  the  form  of  dust; 


135 


and  sometimes  large  quantities  of  it  are  eaten  with 
their  food  by  painters  and  others  who  neglect  to 
wash  their  hands  thoroughly  at  the  dinner  hour. 

Mercury  may  also  enter  the  human  body  through 
the  skin  in  the  form  of  vapor. 

Arsenic  is  a  poisonous  chemical  very  frequently 
used  in  industrial  processes. 

Copper  is  contained  in  bronzes  and  certain  color- 
ing matters,  in  the  dyes  used  with  candies  and  other 
eatables,  and  also  in  some  of  the  paints  applied  to 
toys. 

The  vapors  of  Phosphorus,  to  which  those  who 
work  in  match  factories  are  exposed,  are  very  hurt- 
ful, and  especially  so  in  view  of  the  poor  ventilation 
usual  in  such  places,  while  the  antidote,  ammonia, 
is  not  provided  by  employers.  All  workmen  liable 
to  exposure  in  this  respect  would  do  well  to  observe 
the  strictest  cleanliness,  and  never  to  take  their 
meals  in  the  workshop.  They  ought  to  give  up 
work  or  to  change  their  occupation  as  soon  as  the 
first  bad  symptoms  show  themselves. 

As  a  defence  against  Carbonic  Oxide  and  other 
gases  which  are  developed  in  the  course  of  certain 
manufacturing  processes  it  would  be  best  to  allow 
such  processes  only  in  the  open  air. 

Care  must  be  taken  by  all  who  are  exposed  to 
Animal  Poisons,  glanders,  the  poisons  of  dead 
bodies,  and  that  from  sausages,  and  by  those  whose 


136 


occupations  oblige  them  to  handle  corpses,  meat,  or 
sick  animals,  as  well  as  by  those  who  work  in  skins, 
hair,  bristles,  and  other  animal  products,  that  their 
hands  are  kept  constantly  covered,  especially  when 
even  a  slight  abrasion  of  the  skin  exists.  This  rule 
applies  in  particular  to  physicians,  undertakers, 
veterinary  surgeons,  butchers,  cooks,  shepherds, 
farmers,  tanners,  furriers,  and  soap  makers.  The 
necessary  protection  to  the  hands  may  be  obtained 
by  wearing  rubber  gloves,  or  by  oiling  the  hands 
well  and  washing  them  in  a  solution  of  hyperman- 
ganate  of  potash. 

Workingmen  often  fall  sick  because  they  do  not 
live  rationally  and  do  not  breathe  sufficiently  pure 
air.  Their  homes  are  in  many  instances  unhealthy, 
they  are  apt  to  neglect  cleanliness,  and  for  the  most 
part  they  do  not  eat  proper  food.  A  workingman 
who  follows  out  sensibly  the  rules  we  have  given 
will  find  himself  better  off,  without  any  additional 
expense,  than  his  fellows. 

The  most  healthful  occupations  are  those  which 
require  an  out-door  life,  or  which  are  followed  at 
least  in  a  fresh,  pure  air.  Preeminent  among  these 
may  be  named  gardening,  farming,  and  cattle- 
raising.  Of  course  such  a  rule  has  some  exceptions, 
and,  especially  in  a  country  like  ours,  where  thou- 
sands of  acres  of  virgin  soil  are  broken  every  year, 
the  exhalations  from  the  ground,  to  which,  wo  trace. 


137 


so  many  cases  of  chills  and  fever,  must  be  kept 
constantly  in  mind.  Those  regions  where  malaria 
exists,  even  in  a  moderate  degree  only  at  spring  and 
fall,  cannot  be  healthy  until  a  thorough  system  of 
drainage  has  been  established. 

Living  in  the  country  where  malarial  fever 
abounds  has  ruined  the  health  of  many  a  man,  wo- 
man, and  child.  In  selecting  a  location,  therefore, 
the  mountains  ought  to  be  preferred  to  the  open 
country,  other  things  being  equal.  Farthermore, 
persons  subject  to  bronchial  and  pulmonary  troubles 
can  hardly  do  better  than  to  choose  the  mountains. 


HYGIENE  OF  THE  DWELLING. 


Dwelling-houses  and  apartments  should  be  en- 
sured sufficient  light  and  air  and  a  moderate  temper- 
ature. They  should  be  dry,  not  damp.  Pure,  fresh 
air  is  of  paramount  importance  in  relation  to  the  pre- 
servation of  life  and  health,  for  only  in  a  pure  atmo- 
sphere can  our  blood  be  purijBLed  by  respiration.  About 
half  a  pint  of  air  is  inhaled  with  each  respiration  and 
as  much  exhaled.  It  is  a  sad  fact  that  the  dread  of 
fresh  air,  under  the  name  of  ''a  cold  draft,"  is  so 
general,  and  especially  that  it  is  encouraged  by  some 
physicians.  Cold  drafts  can  be  harmful  only  to 
overheated  and  perspiring  persons.  The  statement, 
*'I  have  caught  a  cold,"  very  frequently  serves  to 
disguise  a  variety  of  disease-producing  causes  which 
may  justly  be  laid  at  the  door  of  the  speaker  himself. 

Compliance  with  nature's  demands  always  pro- 
duces a  feeling  of  agreeable  relief.  What  a  similar 
sensation  accompanies  the  exhalation  of  noxious 
matters  from  the  lungs  and  skin  we  can  appreciate 
only  when  these  processes  are  interfered  witk  We 
should  as  little  think  of  consuming  again  the  exhala- 
tions of  our  skin  and  lungs  as  we  would  our  own 

138 


139 


excretions.  In  the  year  1848,  during  a  severe  storm, 
the  captain  of  the  steamer  ''Londonderry"  confined 
his  two  hundred  passengers  in  a  hold  which  scarcely 
afforded  them  standing-room,  and  sealed  the  hatches. 
Forced  to  breathe  again  and  again  the  same  air,  the 
miserable  inmates  soon  found  their  situation  intoler- 
able, but  contrived  to  force  an  exit  only  after  seventy- 
two  of  their  number  had  expired  from  suffocation. 
Nearly  a  century  earlier  their  commanding  officer 
had  graphically  described  the  intense  suffering  of 
the  one  hundred  and  forty-six  British  soldiers  con- 
fined in  the  Black  Hole  of  Calcutta — their  profuse 
perspiration,  their  raging  thirst,  their  labored  breath- 
ing, their  rapid  heart-action,  their  starting  eyes,  their 
frenzied  struggles  to  reach  the  two  small  windows, 
their  agonizing  cries  for  water  and  for  air,  their 
dehrium,  exhaustion,  death.  After  ten  hours  of  such 
scenes  twenty -three  only  of  the  number  were  taken 
forth  alive.  These  casualties  were  consequent  sim- 
ply upon  the  insufficiency  of  oxygen  and  the  inability 
of  an  already  saturated  atmosphere  to  absorb  the 
exhalations  of  so  many  bodies. 

Frequent  change  of  air  by  efficient  ventilation  is 
not  sufficiently  practiced  either  on  behalf  of  the  sick 
or  of  the  well,  although  abundance  of  fresh  air  is 
well  known  to  favor  health,  while  its  absence  both 
causes  and  aggravates  disease.  In  the  Leopoldstadt 
prison  of  Vienna,  a  building  very  badly  ventilated. 


140 


the  death-rate  during  a  certain  period  was  eighty-six 
per  thousand,  the  larger  nuniber  by  far  from  lung 
diseases  :  in  the  well-ventilated  House  of  Correction 
in  the  same  city  the  death-rate  was  only  fourteen  per 
thousand,  and  little  more  than  half  of  these  from  lung 
complaints. 

The  oxygen  of  the  atmosphere  is  the  most  potent 
disinfectant  for  our  bodies.  In  farmhouses  we  often 
see  bedrooms  made  use  of  as  wardrobes  as  well  as 
for  sleeping  purposes,  dresses  and  clothing  being 
suspended  from  the  walls  and  ceiling.  ISTo  more 
favorable  means  than  this  can  be  imagined  for 
the  collection  and  distribution  of  disease-germs  ; 
and  it  is  a  fact  that  we  often  see  epidemics  of 
diphtheria,  typhoid  fever,  and  other  infectious  dis- 
eases, spread  with  remarkable  rapidity  among  a 
farming  population. 

The  great  value  of  ventilation  is  forcibly  illus- 
trated by  an  occurrence  observed  in  Brooklyn  in  the 
year  1885.  During  that  year  an  epidemic  of  typhoid 
fever,  limited  in  area  to  but  a  few  blocks,  broke  out 
in  the  southern  part  of  the  city.  Many  died  of  it, ' 
but  only  those  were  fatally  attacked  who  had  been 
in  the  country  during  the  preceding  summer  months. 
In  the  adjoining  blocks,  inhabited  by  a  poorer  class 
of  people,  who  had  remained  in  the  city,  no  fatal 
cases  occurred.  The  reason  for  this  partiality  of  the 
fever  is  easily  learned.      These  well-to-do  people, 


141 


before  leaving  town,  had  closed  up  their  houses 
almost  hermetically.  The  gases  which  emanated 
from  the  sewer-pipes  had  become^fixed,  so  to  speak, 
during  their  absence,  having  no  channel  of  escape, 
and  even  after  the  return  of  the  occupants  ventila- 
tion had  not  been  well  looked  after.  In  these  houses 
consequently  the  germs  of  disease  had  found  a  fertile 
soil  for  their  development,  attacking  their  victims 
with  such  vigor  as  to  overwhelm  them.  The  neigh- 
boring poor,  however,  had  not  been  away,  and  their 
rooms  had  been  constantly  ventilated,  so  that  disease 
germs  found  it  hard  to  thrive  there. 

Ventilation  must  be  thorough  and  frequent.  It 
does  not  suffice  to  open  the  windows  a  little  at  the 
top  and  a  little  at  the  bottom,  nor  even  to  open  but 
one  of  them  fully.  All  in  the  room  should  be  thrown 
wide  open  above  and  below,  so  that  not  only  fresh 
air  can  come  in,  but  the  foul  and  vitiated  air  of  the 
interior  can  escape.  The  badly  fitting  doors  and 
windows  of  their  dweUings  afford  poor  people  better 
ventilation,  even  in  winter,  than  they  are  otherwise 
hkely  to  enjoy,  not  a  bad  thing  upon  the  whole,  if 
only  the  house  is  not  situated  upon  ground  too  low 
and  damp. 

It  is  wise  to  pursue  two  methods  of  ventilation 
conjointly.  In  the  first  place,  as  many  windows 
and  doors  as  possible  should  be  thrown  widely  open 
for  about  an  hour  each  evening  before  retiring,  and 


142 


again  in  the  morning  after  the  gentlemen  have  gone 
to  business  and  the  children  to  school.  The  draft 
thus  created  may  bring  in  some  dust  to  settle  on  the 
fine  furniture,  but  this  is  easily  removed ;  and  the 
fact  remains  that  the  foul  air  of  the  room  has  been 
dispelled  and  with  ifc  all  disease-germs  adhering  to 
walls  and  hangings.  Just  as  violent  atmospheric 
disturbances  are  necessary,  particularly  to  large 
cities,  in  order  to  dissipate  the  thick  vapors  con- 
stantly hovering  about,  so  also  must  our  houses  be 
subjected  to  like  violent  measures  of  ventilation. 

A  quieter  method  of  ventilation  is  to  be  followed, 
in  the  second  place,  by  constantly  admitting  fresh 
air  through  windows  kept  always  a  little  open  at  top 
and  bottom.  This  need  not  create  any  draft,  but 
will  simply  promote  continual  interchange  between 
the  inner  and  the  outer  air.  The  same  end  may  be 
attained  by  closing  the  shutters  on  fully  opened 
windows.  Noxious  gases  and  vapors,  dust,  and 
smoke,  must  of  course  be  guarded  against. 

Fumigation  with  aromatic  compounds  is  of  little 
value.  It  conceals  disagreeable  odors,  but  cannot 
change  bad  air  for  good. 

The  air  and  water  which  permeate  the  soil  de- 
mand our  careful  consideration.  They  are  supposed 
to  exercise  a  strong  influence  upon  epidemics  of  in- 
fectious diseases,  like  cholera  and  typhoid  fever.  In 
building  a  house,  therefore,  the  condition  of  neigh- 


143 


boring  Sewerage  should  be  closely  regarded.  No 
surface  water  should  be  allowed  to  collect  about  the 
foundations.  All  cesspools  should  be  situated  as  far 
from  the  house  as  possible,  care  being  taken  to  place 
them  on  a  lower  level  than  the  house  :  otherwise  the 
soil  surrounding  the  house  will  become  saturated 
with  effete  matters  and  will  afford  a  favorable 
nidus  for  the  development  of  disease-germs.  Wells 
must  be  very  far  removed  from  cesspools. 

Pettenkof  er  has  shown  that  the  daily  excretions  of 
an  adult  amount  to  about  three  pounds  of  solid  and 
liquid  matter.  If  no  complete  system  of  sewerage 
exists  in  a  large  city,  his  experience  has  taught  him 
that  hardly  one-tenth  of  these  effete  products  is  actu- 
ally removed.  The  other  nine-tenths  decompose  and 
filter  into  the  ground,  the  more  so,  the  lower  and 
damper  the  locality.  This  has  been  illustrated  number- 
less times  by  the  circumstances  attending  the  spread 
of  epidemics  of  cholera  and  otherinf  ectious  diseases. 
On  high,  dry,  and  rocky  ground  these  diseases  are 
very  rarely  encountered.  Sandy  ground  may  also  be 
held  to  afford  a  healthy  foundation,  since  it  pre- 
vents decomposition  of  contained  matters.  Senator 
and  Fliigge  have  found  that  one  volume  of  sand 
will  absorb  and  hold  two  hundred  and  fifty  volimaes 
of  sewage. 

Koch,  however,  modified  Pettenkofer's  view  by 
showing  that  the  ground  serves  also  as  a  filter,  the 


144 


bacteria  remaining  for  the  greater  part  in  the  upper 
layers,  while  the  purified  liquids  descend  to  lower 
levels.  From  the  surface  of  the  ground  these  germs 
are  washed  almost  completely  away,  either  by 
water  flowing  over  the  surface,  or  by  showers  of 
rain,  and,  collecting  in  streams  and  wells,  originate 
through  drinking-water  a  new  source  of  infection. 
Hence  a  gradual,  but  constant  decrease  in  mortality 
followed  the  introduction  of  sewerage  into  Miinich, 
the  classical  typhoid  city  of  Europe,  and  into  Cal- 
cutta, the  breeding-place  of  cholera.  Upon  the  de- 
velopment of  tuberculosis,  too,  the  purification  of 
the  ground  exercises  a  retarding  influence,  for  since 
the  draining  of  the  site  of  Munich  and  since  the 
introduction  of  a  pure  water  supply  into  that  city, 
the  mortality  of  consumption  has  dimished  by  a  full 
third. 

From  a  bacteriological  point  of  view,  admixture 
of  sewage  with  a  water  can  be  injurious  only  when 
that  sewage  contains  noxious  bacteria.  If,  through 
any  process,  the  sewage  be  freed  from  such  bacteria, 
it  will  be  deprived  of  all  bacteric  infectious  qualities. 
The  most  common  natural  process  by  which  sewage 
is  freed  of  bacteria  is  filtration  through  the  soil.  If 
all  the  bacteria  are  removed,  the  sewage  can  contain 
no  pathogenetic  species,  but  if  they  are  not  all  re- 
moved and  the  sewage  passes  into  a  water  supply, 
the  latter  will  be  in  danger  of  infectious  contamina- 


145 


tion  so  soon  as  the  sewage  contains  pathogenetic 
bacteria. 

A  veritable  pest-hole  exists  in  the  cellar  of  many 
a  house  otherwise  healthily  constructed.  When  dark 
and  damp,  as  so  often  is  the  case,  and  especially 
when  made  the  repository  of  fuel,  ashes,  refuse, 
and  decaying  vegetables  and  fruit,  it  furnishes  a 
most  favorable  spot  for  the  propagation  of  noxious 
germs.  As  a  matter  of  fact  no  part  of  the  house 
demands  more  frequent  inspection  or  more  thorough 
airing.  Its  air  is  constantly  passing,  through  the 
floors  as  well  as  by  way  of  chimney-flues  and  air- 
shafts,  to  the  apartments  above,  and,  unless  con- 
stantly renewed,  carries  with  it  all  manner  of  deadly 
influences. 

The  supreme  sanitary  importance  of  the  removal 
of  all  Sewage  in  order  to  prevent  the  development 
of  disease-germs  is  self-evident.  Several  systems 
have  been  proposed  for  this  purpose.  Among  them 
we  note  the  barrel  system ;  the  pumping  system, 
which  is  in  general  use  in  France  and  Belgium,  and 
which  is  quicker  and  safer  than  the  barrel  system ; 
the  sewer  system,  which  is  best  as  put  in  practice  in 
Berlin.  By  means  of  large  pumps  the  sewage  is 
raised  from  the  sewers  and  poured  over  a  large  tract 
of  land,  upon  which  it  spreads,  and  from  which  it 
runs  off,  after  depositing  its  excrementitious  mat- 
ters.   Although  it  has  been  in  operation  for  only  a 


146 


few  years,  this  system  has  proved  remunerative,  the 
farmers  consenting  to  pay  good  prices  for  the  offal 
thus  collected.  In  this  way  matters  usually  found 
injurious  by  the  inhabitants  of  other  cities  are  turned 
to  account  by  the  people  of  Berlin. 

Where  the  removal  of  excrement  cannot  be  accom- 
plished systematically  and  thoroughly,  care  must  be 
taken  in  regard  to  the  arrangement  and  disposition 
of  the  closets,  particularly  with  a  view  to  the  condi- 
tion of  the  ground.  Decomposition  progresses  very 
rapidly,  and  the  gases  and  exhalations  produced  are 
often  repulsive  in  the  extreme.  Gases  spread  very 
readily  underground,  as  has  been  repeatedly  seen  in 
cases  where  illuminating  gas,  escaping  from  the 
mains,  has  entered  cellars,  basements,  and  even 
higher  floors  of  houses.  In  some  of  these  no  gas- 
pipes  or  fixtures  existed  at  all,  and  still  the  inmates 
fell  sick  from  inhaling  gas  because  a  gas-main  in 
the  neighborhood  had  burst. 

The  principal  hygienic  rules  to  be  observed  in  the 
interest  of  Domestic  Disinfection  are  the  following. 
The  great  danger  of  sewer  gases  entering  our  dwell- 
ing houses  is  best  averted  by  opening  a  connection 
between  the  sewer  pipes  and  a  chimney.  This  fur- 
nishes an  exit  for  the  gases  generated  in  these  pipes, 
gases  whose  lightness  tends  to  force  them  upward, 
and  which  escape  the  more  readily  if  a  fire  is  burn- 
ing in  the  range  or  fire  place  below.     By  this  means 


147 


the  offending  gases  are  either  destroyed  by  fire  and 
smoke  within  the  chimney,  or  else  are  dissipated 
over  the  roof  without  finding  an  opportunity  to 
cause  sickness.  The  pipe  must  not  enter  the  chim- 
ney upon  a  lower  fioor  than  another  opening,  nor 
even  in  its  immediate  vicinity. 

Among  the  most  dangerous  appliances  in  a  mod- 
ern house  are  the  stationary  washbowls  and  the  bath- 
rooms in  its  upper  stories.  Traps  are  wholly  insuffi- 
cient for  their  intended  purpose.  A  better  way  of 
keeping  gases  out  of  the  room^  aside  from  the  ar- 
rangement detailed  above,  consists  in  closing  the 
drain-hole  at  the  bottom  of  a  tub  or  basin  so  as  to 
keep  water  always  standing  there. 

George  E.  Waring,  Jr.,  in  his  article  on  "  Drain- 
age and  Sewerage,"  makes  the  following  remarks  : 
'^  Running  water  confined  within  a  narrow  channel, 
and  so  compelled  to  move  with  force  suflBcient  to 
give  an  energetic  scouring  to  the  walls  of  its  con- 
duit, may  be  trusted  to  carry  with  it  or  to  drive  be- 
fore it  pretty  nearly  all  foreign  matter  that  may 
have  been  contributed  to  it ;  but  the  moment  this 
vigorous  current  is  checked,  that  moment  the  ten- 
dency to  excessive  deposit  begins.  It  is  checked  in 
practice  in  various  ways ;  first,  by  too  great  a  dia- 
meter of  the  pipe ;  second,  by  the  use  of  traps  larger 
than  the  pipes  leading  to  them  and  from  them,  thus 
increasing  the  natural  tendency  of  all  traps  to  stag- 


148 


nation  and  deposit;  third,  by  the  use  of  vertical 
water-pipes,  which  are  almost  universal  and  which 
are  very  often  necessary.  The  velocity  of  a  current, 
measured  along  the  axis  of  the  pipe,  is  less,  if  the 
direction  is  vertical,  than  if  it  is  laid  on  a  steep  slope, 
because  of  the  tendency  of  liquids  flowing  through 
vertical  pipes,  which  they  do  not  fill,  to  adhere  to 
the  walls  and  to  travel  with  a  rotary  movement. 
This  latter  point  is  rather  one  of  curious  interest 
than  of  practical  value. 

'^  However  defective  may  be  the  condition  of  an 
iron  soil-pipe,  vertical  or  horizontal,  it  is  perfection 
itself  compared  with  the  usual  state  of  a  drain  laid 
under  the  cellar  floor.  Under  all  circumstances,  at 
least  in  all  work  hitherto  executed,  one  should  de- 
mand as  absolutely  necessary  that  the  drains  under 
the  cellar  floor  be  removed,  that  the  earth  which  has 
been  fouled  by  the  leakage  of  its  joints  and  its 
breaks  shall  be  taken  out  to  the  clean,  untainted  soil 
below,  and  refilled  with  well-rammed,  pure  earth  or 
with  concrete,  the  drainage  being  carried  through 
a  properly -jointed  iron  pipe  above  the  pavement, 
and  preferably  with  a  fall  from  the  ceiling  of  the 
cellar  to  near  the  floor  at  the  point  of  outlet — in  full 
sight  for  the  whole  distance.  It  sometimes  happens 
that  the  necessity  for  using  laundry-tubs  or  other 
vessels  in  the  cellar  makes  the  retention  of  an 
underground  course   imperative.     When  retained, 


149 


the  drain  should  be  of  heavy  cast  iron,  with  securely 
leaded  joints,  tested  under  a  head  of  several  feet. 
When  found  to  be  tight  and  secure,  it  should  not  be, 
as  ordinarily  recommended,  left  in  an  open  channel 
covered  with  boards  or  flags  and  surrounded  by  a 
vermin  -  breeding,  unventilated,  and  uninspected 
space,  but  closely  and  completely  imbedded  in  the 
best  hydraulic  cement  mortar.  Its  careful  testing 
before  this  enclosure  is  of  course  the  only  condition 
under  which  the  work  should  be  permitted." 

We  would  add,  however,  that  the  very  best  plan 
for  securing  freedom  from  sewer  gas  in  the  dwelling 
is  to  relegate  the  bathroom  and  all  pipes  connected 
with  the  sewers  to  a  small  separate  building,  which 
may  be  connected  with  the  house  by  means  of  a 
long  covered  passage.  This  passage  must  be  thor- 
oughly ventilated  at  all  times,  and  the  doors  opening 
from  either  end  must  be  kept  constantly  closed. 
Glazed  stoneware  or  earthenware  pipes  are  to  be 
preferred  for  house-drains,  and  should  be  laid  in 
well-puddled  clay  or  in  concrete. 

To  demonstrate  the  influence  of  sewer  gas  on  the 
general  health  of  a  community,  the  returns  of  the 
Kegistrar-General  of  Great  Britain  are  cited  by  sev- 
eral authors.  In  the  year  1847  an  order  was  issued 
to  connect  the  privies  in  the  City  of  London  with  the 
general  sewerage  system,  thus  creating  a  direct  com- 
munication between  the  rooms  of  all  the  houses  and 


150 


the  public  drain.  The  mortality  increased  fourfold, 
as  is  shown  by  comparing  the  statistics  of  a  number 
of  years  preceding  1847  with  those  of  a  series  of  years 
following.  This  increase,  or  at  least  a  large  part  of 
it,  can  be  traced  directly  to  the  effects  of  sewer  gas, 
and  to  the  poisoning  of  the  well  water,  particularly 
to  the  former. 

Where  earth  closets  take  the  place  of  sewers,  a 
shovelful  of  earth  should  be  thrown  over  each  dejec- 
tion. The  best  earth  for  the  purpose  consists  of  dry 
clay,  two  parts,  and  loam,  one  part.  Dry  mould  or 
coal-ash  siftings  may  also  be  used.  Green  vitriol 
should  be  thrown  in,  when  an  epidemic  is  threatened 
or  very  hot  weather  prevails. 

Disinfection  is  to  be  accomplished  by  means  of 
antiseptics,  notably  fire,  boiling  water,  chloride  of 
lime  in  solution,  corrosive  sublimate,  sulphurous 
acid,  green  and  blue  vitriol,  carbolic  acid,  chloride 
of  zinc,  the  mineral  acids,  and  chlorine.  It  is  best  to 
use  one  of  the  first  four  mentioned,  following  it 
Up  with  one  of  the  others.  Carbolic  acid  Koch  has 
found  capable  of  stopping  the  development  of  micro- 
organisms when  diluted  with  four  hundred  parts  of 
water,  and  corrosive  sublimate  in  a  solution  of  the 
stren^:th  of  one  to  three  hundred  thousand.  The 
former,  a  product  of  coal-tar,  is  a  clear,  colorless, 
oily  liquid,  which  blisters  the  skin  severely  in  a  few 
moments^  is  extremely  poisonous,  and  rapidly  proves 


151 


fatal.  The  fact  is  to  be  noted  that  pure  carbolic  acid 
is  not  so  good  a  disinfectant,  and  does  not  destroy 
bacteria  with  the  same  certainty,  as  when  diluted 
with  water;  and,  farthermore,  that  it  displays  its 
disinfecting  properties  to  best  advantage  when  in 
combination  with  water  in  the  proportion  of  ten 
parts  in  the  hundred.  Corrosive  sublimate  in  con- 
centrated form  is  also  a  violent  poison,  and  it  may 
be  reckoned  a  great  blessing  to  mankind  that  it  suf- 
fices to  destroy  bacterial  life  in  so  attenuated  a  solu- 
tion as  to  threaten  no  danger  to  the  human  organism. 
A  sublimate  solution  of  one  in  five  thousand,  which 
will  infallibly  destroy  bacilli,  and  which  fully  suf- 
fices for  most  purposes  of  disinfection,  is  nevertheless 
less  poisonous  than  a  ^ve  per  cent,  carbolic  solution. 
In  many  hospitals  a  trial  of  other  disinfectants,  such 
as  boric  and  salicylic  acids,  creolin,  thymol,  and 
salol,  has  resulted  only,  when  a  thorough  destruc- 
tion of  micro-organisms  was  demanded,  in  a  return 
to  one  of  these  two  principal  agents. 

Articles  to  be  disinfected  must  be  spread  out,  not 
left  packed  up  in  a  bundle.  Corrosive  sublimate  at- 
tacks most  metals  in  common  use,  and  must  there- 
fore not  be  poured  into  leaden  pipes.  A  concentrated 
solution  of  corrosive  sublimate  contains  four  ounces 
of  the  chemical  in  a  gallon  of  water.  By  adding  ten 
grains  of  permanganate  of  potash  or  a  pound  of  blue 
vitriol  the  solution  is  colored  and  rendered  recogniz- 


152 


able.  This  solution  should  be  left  to  act  for  about 
two  hours.  Boiling  water  takes  effect  in  thirty 
minutes.  Sulphurous  acid  is  most  efficacious  in 
damp  air. 

The  Dejections  of  a  patient  suffering  from  any 
infectious  disease  should  be  disinfected  before  being 
thrown  into  the  closet,  especially  those  from  cholera, 
typhoid,  or  yellow  fever  patients.  In  the  same  man- 
ner the  vomit  and  the  sputum  of  patients  suffering 
from  cholera,  diphtheria,  scarlet  fever,  and  consump- 
tion should  be  disinfected,  as  well  as  the  receptacles 
used  about  the  sick-room. 

Chloride  of  lime  is  the  best  disinfectant  for  ex- 
crementitious  matters.  A  little  should  be  kept 
constantly  in  the  chamber-vessel.  A  solution  con- 
taining eight  ounces  to  a  gallon  of  water  is  most 
serviceable,  and  is  to  be  stirred  with  the  contents  of 
the  vessel  immediately  after  use.  Cholera  dejections 
must  be  disinfected  for  four  hours  with  a  five  per 
cent  carbolic  solution.  ISTapkins,  towels,  and  other 
fabrics  infected  with  disease  germs  should  be  burned 
or  thrown  into  a  two  per  cent,  carbolic  solution, 
or  into  one  of  chloride  of  lime.  The  latter  is  an  ap- 
propriate disinfectant  for  physicians  and  nurses  to 
wash  their  hands  in.  Bandages  should  under  all 
circumstances  be  thrown  away,  or,  still  better, 
burned. 

Beds  and  Clothing  are  best  Disinfected  with  a 


153 


solution  of  corrosive  sublimate,  of  the  strength  of 
one  part  in  two  thousand  of  water,  or  with  a  two 
per  cent,  carbolic  acid  solution.  Wearing  apparel 
must  be  exposed  to  the  action  of  steam  for  thirty 
minutes,  and  afterwards  spread  out  or  hung  up  to 
air. 

To  fumigate  and  disinfect  sick-rooms,  houses, 
and  ships,  sulphur  is  usually  burned.  Several 
pounds  in  broken  pieces  are  thrown  into  an  iron 
vessel,  standing,  for  fear  of  conflagration,  upon 
bricks  in  a  vessel  filled  with  water.  Alcohol  is 
poured  over  the  mass  and  the  match  is  then  applied. 
The  doors  and  windows  should  be  kept  tightly  closed 
for  many  hours,  while  the  sulphurous  acid  developed 
by  the  burning  sulphur  does  its  work.  To  ensure 
thorough  efficacy  the  room  must  contain  an  abund- 
ance of  watery  vapor  before  the  process  begins. 
Sublimate  may  be  used  in  the  same  manner,  a 
pound  being  usually  sufficient.  The  mercurial  va- 
pors developed  are  more  deadly  in  their  action  than 
those  of  sulphur.  A  pan  of  burning  charcoal  must 
be  placed  beneath  the  vessel  containing  the  subli- 
mate. 

Valuable  Furniture  may  be  Disinfected  by  ex- 
posure to  fresh  air  for  at  least  a  month.  Carpets, 
curtains,  and  furniture  are  best  removed  from  the 
sick  room  at  the  outbreak  of  disease,  only  such  of 
them  being  retained  as  can  be  easily  disinfected.    A 


154 


solution  of  some  reliable  disinfectant  should  then  be 
prepared  and  kept  always  at  hand  ready  for  use 
when  required. 

Mattresses  should  be  opened,  and  the  hair  steamed 
and  then  picked  and  exposed  to  the  air.  It  is  well 
to  rub  floors,  walls,  and  articles  of  furniture  with  a 
rag  saturated  in  a  solution  of  carbolic  acid,  chloride 
of  lime,  or  corrosive  sublimate  of  the  strength  al- 
ready given.  Sick  roonas  ought  to  be  fumigated 
several  times  with  sulphur  or  sublimate,  and  then 
thoroughly  ventilated.  Walls  are  best  disinfected 
by  rubbing  them,  as  Professor  Esmarch  recom- 
mends, with  stale  bread.  If  the  walls  are  papered, 
it  is  safest  to  strip  off  the  paper  entirely. 

The  Disinfection  of  Cesspools  must  be  accom- 
plished by  the  use' of  such  antiseptics  as  dry  earth, 
pulverized  charcoal,  chloride  of  zinc,  green  vitriol, 
or,  best  of  all,  by  a  one  to  five  hundred  sublimate 
solution.  Cesspools  must  be  emptied  very  frequently. 
Every  part  of  a  privy,  and  especially  the  woodwork, 
should  be  thoroughly  washed  with  the  sublimate 
solution,  after  which  dry  sand  should  be  scattered 
about,  or  a  powder  consisting  of  one  part  of  chloride 
of  lime  with  nine  parts  of  plaster  of  paris. 

In  order  to  be  healthy  a  house  must  be  kept  dry 
and  clean.  Odds  and  ends  lying  about  are  not  only 
disgusting  to  an  eye  used  to  order  and  neatness,  but 
they  may  in  times  of  epidemic  become  active  agents 


155 


in  fostering  the  germs  of  disease.  Soiled  dishes  and 
remnants  of  food  are  equally  inimical  to  health  and 
to  cleanliness.  Meat,  milk,  flour,  and  similar  articles 
of  food,  if  not  kept  in  an  ice  chest  or  meat  safe, 
should  not  at  least  be  left  uncovered. 
I  It  is  always  harmful  to  live  for  any  length  of 
'time  in  rooms  that  are  damp  or  cold,  rooms  having 
walls  dripping  with  dampness  or  floors  wet  from 
scrubbing,  and  rooms  where  clothes  are  hung  to  dry. 
The  more  moisture  the  air  contains,  the  less  capable 
is  it  of  absorbing  the  vapors  of  our  breath  and  with 
them  the  disease-germs  we  sometimes  exhale.  These 
are  then  partially  retained,  and  impede  the  inhalation 
of  pure  air  rich  in  orygen.  This  interference  with 
evaporation  from  the  lungs  and  skin  is  very  hurtful. 
It  renders  difficult  the  cooling-off  process  which  our 
bodies  constantly  require,  it  almost  arrests  and  quite 
neutrahzes  the  activity  of  our  skin,  and  interferes 
with  the  purification  of  the  blood.  The  best  proof 
of  these  statements  is  found  in  the  distressing  in- 
fluence of  so-called  ^'  muggy  weather,"  when  the 
temperature  of  the  air  is  not  excessive,  but  the  hu- 
midity of  the  atmosphere  is  considerable.  Dry  heat 
at  from  ninety  to  one  hundred  degrees  Fahrenheit 
is  easier  borne  than  temperatures  below  ninety  de- 
grees when  the  humidity  is  at  the  point  of  satura- 
tion. Damp  air  which  is  at  the  same  time  cold  is 
more  objectionable  than  damp  warm  air.    On  the 


156 


other  hand  very  dry  air  in  living-rooms  is  very  un- 
healthy. This  condition  is  particularly  found  in 
rooms  heated  by  steam,  by  hot  water  pipes,  or  in 
those  heated  by  means  of  a  furnace,  a  heater,  or 
even  a  common  stove.  A  vessel  containing  water 
should  be  kept  in  every  such  room  upon  the  stove 
or  near  the  register.  The  air  heated  by  a  furnace 
should  pass  over  water  before  entering  the  room. 

Its  Situation  is  a  most  important  factor  in  the 
choice  of  a  dwelling.  The  climate,  the  direction  in 
which  it  faces,  its  altitude,  its  location  upon  a  hill- 
side or  in  a  valley,  the  neighboring  rivers,  ponds, 
lakes,  swamps,  and  marshes,  whether  upon  dry, 
sandy,  or  rocky  soil,  all  these  features  are  to  be  con- 
sidered. The  severity  of  the  sun's  rays,  the  prevail- 
ing direction  of  the  wind,  temperature,  and  humidity 
vary  in  different  localities.  Rooms  facing  south  are 
warmer,  but  subject  to  greater  changes  of  temper- 
ature; those  facing  north  are  cooler,  but  preserve  a 
more  equable  temperature.  Houses  situated  in  deep 
forests  or  lying  between  dense  clumps  of  large  trees 
are  apt  to  be  unhealthy  from  dampness.  But  a  wood 
at  some  distance  from  the  house  is  an  advantage, 
since  it  furnishes  abundance  of  oxygen  besides  pro- 
tection from  wind  and  excessive  heat. 

Walls  built  of  porous  stone  are  in  themselves  an 
excellent  means  of  ventilation,  and  are  moreover  dry, 
while  brick  walls  absorb  a  large  amount  of  water 


i:r 


and  retain  it  for  a  long  time.  Houses  situated  on 
wide  streets  are  lighter  and  afford  better  air  and 
more  freedom  from  dampness  than  those  built  on 
narrow  streets.  Detached  houses  are  for  a  similar 
reason  preferable  to  those  built  in  blocks,  and  an 
advantage  is  also  found  in  freedom  from  the  too 
close  proximity  of  shade-trees. 

It  is  very  desirable  that  the  roof  of  a  house  should 
be  available  as  a  resting-place  upon  summer  even- 
ings, in  the  old  Roman  way,  and  especially  is  this 
true  of  malarial  districts,  since,  the  farther  we  are 
removed  from  the  ground,  the  less  is  the  fear  of 
infection,  although  upon  damp  evenings  it  will  be 
found  better  to  avoid  the  open  air  even  upon  the 
roof.  Wooden  houses  should  be  painted  with  a  light 
color^  and,  if  possible,  some  creeping  plant  should 
be  allowed  to  climb  the  walls  as  a  protection  against 
the  fierce  rays  of  the  sun. 

No  dwelling  should  be  situated  within  an  eighth 
of  a  mile  of  a  Graveyard.  Still  more  important  is  it 
that  none  should  be  built  nor  any  well  dug  upon  a 
slope  below  a  graveyard.  Decomposition  begins  in 
the  human  body  almost  immediately  after  death, 
and  continues  for  a  longer  or  shorter  period,  accord- 
ing to  the  quality  of  the  soil  and  other  circumstances. 
''A  porous  soil,"  says  Ford,  ''through  which  there 
is  an  active  change  of  air  and  water,  hastens  the 
return  of  the  body  to  its  natural  elements.    The  pro- 


158' 

ducts  of  decomposition  are  carbonic  acid,  carburetted 
and  sulphuretted  hydrogen,  ammonia,  nitrous  and 
nitric  acids,  and  various  more  complex  gaseous 
compounds  and  offensive  organic  vapors,  which  are 
resolved  into  simpler  combinations  by  the  oxidizing 
power  of  the  soil.  The  non-volatile  substances  re- 
main in  the  ground,  are  taken  up  by  the  roots  of 
plants,  or  are  washed  away  by  water  passing  through 
the  pores  of  the  soil.  Soils  differ  very  much  in  the 
manner  in  which  they  effect  these  destructive 
changes.  There  are  grounds  in  which  a  corpse 
may  be  completely  destroyed  in  three  or  four  years, 
and  others  in  which  twenty-five  or  thirty  years  will 
be  required  for  the  effectual  decomposition  of  the 
body.  If  there  be  a  proper  selection  of  the  ground, 
with  especial  reference  to  the  facility  of  constant 
change  of  air,  and  if  its  powers  be  not  overtaxed, 
the  powerful  absorbent  and  oxidizing  qualities  of  the 
soil,  aided  by  the  action  of  growing  plants,  may  be 
depended  on  to  dispose,  in  a  harmless  manner,  of  the 
gases  and  vapors  evolved  during  decomposition. 
If,  on  the  other  hand,  these  precautions  are  not 
observed  ;  if  a  soil  be  chosen  in  which  there  is  stag- 
nation of  air  and  water  ;  if  the  bodies  are  buried  in 
close  contact  and  with  an  insufficient  covering  of 
earth, — the  offensive  gases  and  putrid  vapors  evolved 
in  the  process  of  decomposition  will  accumulate  and 
assume  dangerous  proportions.    The  ground  becomes 


loD 


saturated  with  these  foul  products  to  such  a  degree 
as  to  be  incapable  of  further  absorbing  them,  and 
the  air  and  water  of  the  locality  are  poisoned  by  the 
noxious  matters  emitted  from  the  surcharged  soil. 
Such  burial-grounds  are  an  evil,  no  matter  where 
located ;  but  when  situated  in  close  proximity  to 
dwellings,  they  are  undoubtedly  most  detrimental 
to  health." 

Contamination  from  dead  bodies  usually  occurs 
through  the  agency  of  wells  and  other  sources  of 
supply  for  drinking-water,  which  collect  the  drainage 
of  cemeteries.  The  utmost  care  must  be  taken  there- 
fore that  wells,  ponds,  and  reservoirs  are  far  removed 
from  such  localities.  No  dwelling  should  ever  be 
allowed  in  the  valley  below  a  graveyard,  unless  a 
watercourse  of  some  size  intervenes,  and  not  even 
then  unless  the  stream  has  a  rapid  current  and  a 
gravelly  bed. 

It  is  best  not  to  live  near  a  factory,  mine,  or  hos- 
pital, since  injurious  gases,  vapors,  and  dust  parti- 
cles may  be  developed  there.  Swamps  and  Marshes, 
too,  are  bad  neighbors,  for  the  humid  air  is  often 
vitiated  by  the  emanations  of  decomposing  animal 
and  vegetable  matter.  These  are  very  unhealthy, 
often  causing  marsh  fever,  malaria,  and  other  ail- 
ments. In  tropical  and  sub-tropical  regions,  where 
cold  northern  winds  are  unfelt,  such  swamps  may  be 
rendered  harniless  by  planting  eucalyptus  trees  in 


160 


ilielr  vicinity;  and  eun-flowers,  in  the  temperate 
zone,  may  be  made  to  serve  a  similar  purpose  in  some 
degree,  especially  when  planted  in  large  numbers. 

In  the  general  plan  of  their  arrangement  Ameri- 
can Dwelling-houses  are  usually  modeled  upon  the 
English  pattern,  being  intended  for  the  use  of  only 
a  single  family.  The  great  advantages  of  this  plan, 
so  far  as  privacy  is  concerned,  are  not  to  be  denied ; 
but,  in  respect  to  health,  one  important  objection 
exists  in  the  large  amount  of  stair-climbing  entailed 
upon  a  diligent  housewife  and  upon  her  servants. 
Ladies  whose  hearts  or  chests  are  weak  have 
learned  this  in  some  instances  to  their  cost.  Cases 
in  which  the  degenerative  changes  taking  place  in 
the  lungs,  or  more  frequently  in  the  heart,  have 
been  hastened  to  a  fatal  termination  are  well  au- 
thenticated. For  such  individuals  the  Continental 
arrangement  is  far  the  best.  In  most  countries  of 
Europe  the  houses  are  much  larger  than  here,  and 
each  story  is  arranged  as  a  complete  suite  of  rooms 
for  one  family.  The  front  door  of  the  building  is 
constantly  open  during  the  daytime,  and  leads,  by 
means  of  a  broad  passage-way,  into  a  courtyard, 
generally  of  good  size.  Such  an  adjustment  insures 
good  ventilation,  with  a  plentiful  supply  of  fresh  air. 
The  '^  French  flats,"  so  called,  in  our  large  cities,  are 
similarly  arranged,  but  one  marked  difference  exists, 
of  which  farther  on. 


m 

The  Carpets  of  a  house  claim  a  special  mention 
from  us.  The  plan  of  carpeting  floors  to  which  we 
are  accustomed  is  a  decidedly  unhealthy  one.  When 
the  carpets  are  nailed  to  the  floor  in  such  a  way  that 
every  portion  is  covered,  the  dust  which  settles  upon 
them  can  be  only  partially  removed  by  sweeping, 
and  accumulates  in  increasing  quantity  upon  the 
planking  below  as  well  as  in  the  meshes  of  the  carpet 
itself.  This  dust,  continually  raised  by  every  foot- 
step, inevitably  renders  the  air  unhealthy;  and  the 
evil  is  increased  by  the  layers  of  thick  paper  and 
cotton  wadding  usually  interposed  between  the  floor 
and  the  carpet  by  way  of  lining. 

The  method  which  prevails  in  Europe,  and  which 
is  now  largely  imitated  by  well-to-do  people  here,  is 
quite  different.  In  accordance  with  this  plan  the 
floor  should  be  inlaid,  or  at  any  rate  laid  in  hard 
woods,  and  should  be  frequently  polished  with  wax. 
One  large  carpet  is  used  to  cover  the  greater  part  of 
the  room,  or  perhaps  rugs  are  spread  in  different 
places,  beneath  tables,  and  before  sofas,  pianos,  book- 
cases, and  other  articles  of  furniture,  much  as  we 
are  accustomed  to  lay  them  upon  our  carpets.  This 
insures  much  greater  cleanliness  and  a  remarkable 
absence  of  dust,  for  even  the  largest  rug  can  be 
readily  taken  up  and  shaken  as  often  as  necessary, 
without  waiting  for  the  annual  housecleaning,  of 
which  our  dames  stand  in  such  dread.    It  is  a  fact 


m 


well  known  that  at  this  periodical  season  of  renova- 
tion danger  always  exists  of  infection  by  some  dis- 
ease whose  germs  are  lurking  in  the  carpets  or  in 
the  crevices  of  the  floor.  Perhaps  the  best  form  of 
floor-covering  under  all  circumstances  is  linoleum, 
since«germs  and  dirt  find  it  diflicult  of  invasion,  and 
since  it  can  easily  be  cleaned  with  thoroughness. 

Windows,  too,  are  better  constructed  abroad.  Our 
frames,  balanced  by  weights  upon  cords,  render  it 
impossible  to  utilize  more  than  one-half  of  the  entire 
opening  for  ventilation  at  a  given  time.  In  Europe, 
however,  the  frames  hang  upon  hinges  and  close 
together  in  the  middle,  like  glass  doors  leading  to  a 
balcony,  so  as  to  leave  the  entire  space  available  for 
ventilation  when  required. 

The  evils  attendant  upon  the  presence  of  gas 
pipes  and  fixtures  it  would  be  difl&cult  to  escape 
unless  by  replacing  the  gas  by  the  use  of  Electric 
Light.  This  would  be  an  advantage  from  another 
than  a  hygienic  point  of  view,  for  statistics  taken 
in  factories  prove  that  electic  light  is  far  better  for 
the  eye  than  gaslight. 

Far  more  objectionable  than  our  private  houses, 
or  the  large  continental  dwellings  let  in  separate 
floors,  are  the  Tenement  Houses  and  the  large  ma- 
jority of  so-called  French  flats  in  our  large  cities. 
Eeal  French  flats  have  at  least  one  court  yard,  sur- 
rounded by  the  four  wings  of  the  building,  and  fur- 


m 


hishing  abundance  of  light  and  air.  Such  an 
arrangement  is  only  partly  carried  out  in  the  large 
flat  and  apartment  houses  which  have  lately  come 
into  vogue  among  us.  These  resemble  for  the  most 
part  the  continental  style  of  houses.  But,  in  common 
with  tenement  houses,  they  have  in  reality  only  one 
light  room,  sometimes  two,  one  facing  the  street  and 
the  other  looking  toward  the  rear  of  the  building. 
The  remaining  rooms,  from  two  to  four  in  number 
have  no  direct  source  of  light  and  air,  but  are,  for 
the  most  part,  dark  and  close,  being  lighted  and  ven- 
tilated only  through  other  rooms.  It  is  only  lately 
that  air-shafts  begin  to  be  built  in  such  buildings,  but 
even  the  modicum  of  air  and  light  obtained  in  this 
way  is  dearly  paid  for  in  loss  of  comfort.  Privacy 
is  no  longer  assured,  since  nearly  every  word  spoken 
can  be  distinctly  heard  through  the  air-shaft  upon 
the  floors  above  and  below.  Moreover,  free  access 
is  afforded  from  each  story  to  every  other  for  the 
odors  of  the  kitchen  and  the  chamber,  as  well  as  for 
the  germs  of  disease.  And  last,  but  not  least,  among 
their  evils  stands  the  danger  during  fire  which  these 
shafts  constantly  threaten. 

In  tenement  and  apartment  houses  the  bedrooms 
are  of  necessity  the  dark  and  close  rooms  situated 
between  the  two  light  ones.  Although  many  of 
these  communicate  by  small  square  windows  with 
the  stair-case  or  air-shaft,  which  is  almost  always 


164» 


dark,  this  is  the  poorest  kind  of  makeshift,  since  the 
air  procured  from  this  source  is  often  the  worst  im- 
aginable. The  good  old  rule,  that  the  kitchen  must 
be  as  far  as  possible  removed  from  the  living-rooms, 
and  especially  from  the  sleeping-rooms,  can  in  these 
houses  never  be  complied  with. 


CLIMATE. 

The  climate  we  live  in  is  of  very  great  import- 
ance as  regards  our  well-being.  Cold  increases  the 
rapidity  of  the  combustion -process  going  on  in  our 
bodies.  To  meet  this  increased  tissue-change  we 
must  dress  warmly  and  must  eat  heartily.  The 
climate  of  the  tropics  on  the  contrary  slows  this 
process  of  combustion,  and  there,  accordingly,  we 
require  less  oxygen,  and  must  dress,  therefore,  very 
lightly,  at  least  in  the  day  time,  and  reduce  the 
amount  and  richness  of  our  food. 

It  is  best  to  visit  tropical  countries  only  during 
winter,  and  to  resort,  if  possible,  to  regions  which 
are  high  and  dry,  particularly  to  those  which  are 
exposed  to  cool,  refreshing  winds.  Too  great  care 
cannot  be  taken  in  tropical  regions.     Plain,  easily 


165 


digestible  food,  preferably  vegetables,  should  be 
moderately  partaken  of.  The  stomach  must  never 
be  allowed  to  become  empty  nor  to  be  overloaded, 
and  alcoholic  liquors  of  every  description  are  to  be 
avoided.  Loose  garments  of  wool  should  be  worn, 
or,  if  unobtainable,  of  cotton,  and  some  form  of 
light  head-covering,  which  will  give  ample  protec- 
tion from  the  sun's  rays.  At  night  a  flannel  belt 
should  be  worn,  for  it  must  always  be  remembered 
that  the  nights  are  apt  to  be  cool,  however  intense 
the  heat  of  the  day,  and  one  should  take  great  care 
not  to  expose  one's  self  to  cold,  dew,  and  cool  winds. 
No  one  should  sleep  in  the  open  air,  and  excitement 
of  every  kind  should  be  avoided. 

A  constant  watch  should  be  observed  by  residents 
in  this  enervating  climate  against  that  impairment 
of  vital  energy  which  is  so  apt  to  attack  those  born 
in  the  north,  and  which  is  not  wholly  unknown  to 
the  native  population.  The  first  sign  of  this  condi- 
tion should  be  taken  as  a  warning  to  repair  to  a 
cooler  and  healthier  locality.  The  climate  of  the 
temperate  zone  is  healthiest.  The  change  of  sea- 
sons, the  variable  temperatures  and  winds,  are 
natural  stimulants,  which  influence  health  favor- 
ably and  render  life  more  enjoyable.  Sudden  and 
marked  changes,  however,  such  as  so  frequently 
occur  in  this  country,  cannot  be  otherwise  than  pre- 


166 


judicial  to  health.  The  difference  in  this  respect 
between  Europe  and  America  is  due  to  a  certain  ex- 
tent to  the  different  direction  of  the  large  mountain 
chains.  While  upon  this  continent  the  Rocky  and 
the  Alleghany  chains  of  mountains  extend  from 
north  to  south,  in  Europe  the  Alps,  the  Carpathian 
mountains,  the  Balkans,  and  other  chains  run  from 
east  to  west.  By  this  circumstance  the  prevailing 
direction  of  the  winds  is  materially  influenced,  and 
so,  in  this  country,  cold  northerly  and  hot  southerly 
winds  alternate.  Exceptions  to  this  rule  may  be 
found  upon  some  of  the  slopes  of  the  Blue  Hills,  as 
well  as  in  certain  regions  of  Colorado,  New  Mexico, 
Utah,  Southern  Montana,  Idaho,  and  Oregon,  which 
are  protected  from  northerly  winds,  and  which  are 
the  healthiest  portions  of  America,  perhaps  of  the 
world. 

The  sanitary  offices  of  large  forest  tracts  are 
manifold.  They  protect  from  wind,  dust,  and  dis- 
ease, suppressing  the  germs  of  the  latter,  equalize 
temperature  in  summer  as  well  as  in  winter,  and 
attract  rain  and  other  forms  of  humidity.  The  in- 
creasing destruction  of  forest  lands  causes  a  corre- 
sponding increase  in  unfavorable  climatic  changes. 
It  is  an  opinion  extensively  held  by  seafaring  people 
and  others  that  the  constantly  diminishing  area  of 
forest  land  in  pur  country  is  justly  to  be  considered 


167 


one  of  the  causes  of  the  increase  in  frequency  and 
violence  of  such  meteoric  disturbances  as  tornadoes, 
cyclones,  gales,  and  hurricanes.  The  opposite  con- 
ditions are  seen  in  the  Argentine  Republic,  where 
pampeiros,  wind-storms  of  terrific  violence,  have 
greatly  decreased  in  number  and  intensity  since 
forests  have  grown  up  extensively. 


PART   SECOND. 


THE  CARE  OF  THE  SICK. 


The  complete  understanding  of  a  given  complaint 
is  not  made  possible  simply  by  a  knowledge  of  the 
patient's  sensations,  nor  by  that  of  his  apparent  func- 
tional disturbances.  The  exact  determination  of  phy- 
sical conditions  and  qualities  is  no  less  indispensable. 
This  determination  of  symptoms,  which  to  the  phy- 
sician are  of  the  utmost  value  because  they  evidence 
changes  which  can  be  seen,  heard,  felt,  numbered, 
measured,  or  weighed,  is  possible  moreover  only  by 
the  aid  of  physical  diagnosis,  and  only  to  the  able 
physician,  skilled  in  such  methods  of  investigation 
as  inspection,  palpation,  percussion,  auscultation, 
and  chemical  and  microscopical  examination.  It  is 
only  by  the  aid  of  physical  diagnosis  and  other  scien- 
tific methods  of  inquiry  that  certainty  can  be  attained 
in  regard  to  a  disease  which  evidently  exists,  and  a 
physician  who  fails  to  employ  these  methods  of  in- 
vestigation is  to  be  considered  undeserving  of  con- 
fidence.   Especially  is  it  true  that  physical  diagnosis 

169 


170 


is  absolutely  indispensable,  inasmuch  as  entirely 
distinct  diseases  frequently  present  subjectively  and 
functionally  just  the  same  symptoms,  although  very 
different  ones  physically ;  while,  on  the  other  hand, 
one  and  the  same  disease  may  in  different  instances 
occasion  altogether  different  sensations  and  func- 
tional disturbances. 


NURSING. 

Before  giving  special  instructions  for  the  man- 
agement of  any  individual  ailment,  we  wish  to  call 
attention  to  certain  general  rules  which  are  to  be 
regarded  in  every  instance. 

A  diseased  organ  demands  the  greatest  indul- 
gence. An  unsound  leg  must  not  be  used  in  walk- 
ing, running,  or  jumping ;  a  disturbed  stomach  must 
not  be  tried  by  indigestible  food ;  hoarseness  inter- 
dicts talking,  singing,  and  shouting;  weak  eyes 
should  avoid  a  bright  light ;  a  short-winded  person 
must  not  hurry  in  going  up  or  down  a  staircase,  or 
on  the  slqpe  of  a  hill.  It  is  against  this  cardinal  rule 
that  the  larger  number  of  offences  is  committed, 
especially  during  the  convalescence  of  a  diseased 
meraber.    Most  patients  find  it  hard  to  await  quietly 


171 


the  complete  healing  and  restoration  of  an  impaired 
organ,  but  would  hasten  to  burden  a  part,  still  weak 
and  but  imperfectly  recovered,  with  tasks  beyond  its 
capacity.  The  unwelcome  result  is  that  the  disease 
breaks  out  afresh  and  assumes  now  a  graver  char- 
acter and  a  more  lingering  type.  Especially  in 
typhoid  fever  do  we  often  see  a  fatal  recurrence, 
and  no  physician  should  omit  to  caution  a  patient 
convalescing  from  this  disease  against  the  very 
dangerous  consequences  of  departing  from  the  pre- 
scribed diet. 

The  patient  should  observe  a  well-balanced,  rest- 
ful self-restraint,  avoiding  everything  at  all  out  of 
the  ordinary.  It  is  surprising  how  many  persons  in 
sickness  feel  constrained  to  do  something  strangely 
inconsistent  with  their  condition.  This  may  be 
thought  the  reason,  in  no  small  number  of  instances, 
why  at  a  certain  point  an  illness  is  disturbed  in  its 
otherwise  favorable  course  and  begins  an  advance 
toward  a  fatal  termination.  It  would  be  much  better 
for  every  patient  to  remain  in  his  room,  if  not  in  bed, 
up  to  the  end  of  the  period  of  illness,  quite  as  care- 
fully as  at  its  beginning. 

Everything  furnished  the  patient  should  be  of  the 
best  quality.  Above  all,  at  night  as  well  as  during 
the  day,  the  air  of  the  sick-room  should  be  pure  and 
free  from  drafts  and  from  dampness.  The  mattress 
must  not  be  too  high,  the  temperature  of  the  room 


172 


must  preserve  an  equable  medium,  and  the  food 
must  be  easily  digested  and  moderately  nutritive, 
while  the  drinks  should  be  mild  and  unirritating. 
All  unusual  excitements  are  to  be  avoided,  as  well  as 
efforts  of  the  mind,  senses,  or  body,  glaring  lights, 
loud  noises,  and  disagreeable  odors.  > 

Very  often  we  find  it  to  be  the  case,  and  not  a 
little,  it  may  be,  to  the  injury  of  the  patient,  that  he 
is  either  greatly  overfed,  or  that  nearly  all  nourish- 
ment is  withheld  from  him.  Generally  the  rule  is  to 
give  little  food  at  a  time  and  to  repeat  it  frequently. 
Food  prepared  for  the  sick  should  always  be  of  the 
best  quality  and  cooked  with  the  utmost  care.  The 
nurse  should  bear  in  mind  that  her  task  is  that  of 
supplementing  an  impaired  digestion.  Food  should 
be  served  at  regular  intervals,  and  speedily  removed 
if  not  promptly  eaten. 

Under  no  circumstances  may  the  sick-room  be  al- 
lowed to  go  unaired,  the  patient's  linen  to  remain 
long  without  changing,  or  his  body  to  stand  in  need 
of  bathing.  In  nearly  every  complaint  the  functions 
of  the  skin  are  subject  to  more  or  less  disturbance, 
and  in  many  grave  diseases  it  is  through  this  chan- 
nel almost  exclusively  that  nature  finds  means  of  re- 
lief. The  poisonous  excretions  are  merely  thrown 
out  by  the  skin,  not  carried  away  from  its  surface. 
!N^othing  but  soap  and  water  can  effect  that.  If  we 
permit  a  sick  person  to  remain  unwashed,  or  his 


in 

clothing  to  be  worn  after  it  has  become  saturated 
with  perspiration,  we  interfere  just  as  much  with  the 
natural  processes  of  tissue  change  as  if  a  slow  poison 
were  given  by  the  mouth:  the  only  difference  lies  in 
the  less  rapid  action  of  the  former. 

Special  care  should  be  observed  in  the  use  of 
water  for  Bathing  in  the  case  of  persons  suffering 
from  debility,  the  result  of  sickness  or  of  age.  In 
such  persons  it  is  often  seen  that  a  bath,  such  as  was 
used  with  benefit  in  robust  health  or  in  younger 
years,  is  followed  now  by  palpitation  of  the  heart, 
slackened  pulse,  more  or  less  vertigo,  shivering,  and 
other  feelings  of  discomfort,  lasting  for  some  time 
after  its  use.  In  ordinary  cases  it  may  be  accepted 
as  a  good  rule  that  whenever  a  bath,  hot,  tepid,  or 
cold,  is  followed  by  a  sense  of  oppression  or  by  in- 
convenience of  any  kind,  it  has  done,  not  good,  but 
harm. 

Baths,  more  especially  tepid  and  cool  ones,  are 
often  employed  by  physicians  in  the  reduction  of 
temperature.  In  long-continued  illnesses  the  physi- 
cian and  nurse  must  pay  particular  attention,  during 
the  patient's  bath  and  the  change  of  his  bed-linen,  to 
the  condition  of  his  back  and  hips,  in  order  to  ascer- 
tain if  bedsores  exist,  and,  should  they  discover  the 
reddish  discoloration  which  marks  the  appearance 
of  these  distressing  ulcers,  appropriate  treatment 


IH 


must  at  once  be  instituted.  The  time  consumed  hy 
a  patient's  bath  should  not  be  unduly  prolonged,  and 
the  same  is  to  be  said  in  regard  to  thin-skinned  indi- 
viduals when  in  health.  As  soon  as  a  chilly  feeling 
arises  the  bath  should  come  to  an  end. 

When  a  bath  is  objectionable,  the  best  substitute 
is  found  in  chafing,  wrapping  in  wet  towels,  or  in 
sponging  followed  by  thorough  drying.  In  severely 
painful  affections  of  the  chest  or  abdomen  the 
earliest  relief  may  often  be  obtained  by  means  of 
a  Priesnitz  Dressing.  For  this  purpose  a  sheet  is 
folded  neatly  and  evenly  to  the  width  of  the  body, 
and  one  end  of  it  is  dipped  in  water  and  wrung  out 
until  it  ceases  dripping ;  then  the  wet  half  is  applied 
to  the  chest  or  abdomen  and  the  whole  sheet  is  wound 
as  tightly  as  possible  about  the  body,  so  that  the  dry 
portion  overlies  the  wet  portion.  By  this  means  an 
agreeable  warmth  is  established  for  three  or  four 
hours. 

Of  still  greater  importance  than  the  cleansing  of 
the  skin  is  that  of  the  mucous  membranes  as  a 
measure  of  precaution  against  the  adhesion  of  dis- 
ease germs  as  well  as  against  digestive  disturbances. 
If  the  patient  is  unable  to  cleanse  his  own  nose, 
mouth,  and  pharynx,  some  one  else  should  do  this 
for  him,  by  wiping  off  the  membrane  of  these  regions 
as  oarefuUy  as  possible  with  a  sponge  or  pledget 


17^ 


dipped  in  the  disinfectant  solution  the  doctor  has 
ordered.  The  cloths  or  sponges  used  for  this  purpose 
should  be  immediately  burned. 

Spittoons  and  Chamber-vessels  require  thor- 
ough cleansing.  As  soon  as  possible  after  use  the 
contents  of  these  vessels  should  be  disinfected  and 
emptied.  Under  no  circumstances  ought  they  to 
be  allowed  to  stand  uncovered.  The  cover  of  a 
chamber-vessel  is  always  coated  when  in  use  with  a 
pungent,  badly-smelling  moisture,  which  the  ab- 
sence of  a  cover  would  have  allowed  to  permeate 
the  atmosphere  of  the  room.  When  emptied,  the 
vessel  should  be  cleansed  along  with  its  cover,  filled 
with  water  or  with  a  carbolic  solution,  and  set  aside 
for  a  considerable  time  to  air.  Meanwhile  another 
vessel  should  be  employed.  The  vessels  preferable 
for  use  in  the  sick-room  are  those  of  earthenware, 
porcelain,  or  well- varnished  wood.  Wooden  earth- 
closets  are  objectionable,  since  they  cannot  be 
thoroughly  disinfected  and  are  therefore  liable  to 
disseminate  disease.  The  waste  bucket  must  never 
be  brought  into  the  sick-room,  but  all  vessels  emptied 
and  cleansed  in  the  water-closet  instead. 

Every  appurtenance  of  the  sick-chamber,  and 
especially  the  patient's  Bed,  unless  some  reason 
exist  to  the  contrary,  must  be  subjected  once  or 
more  each  day  to  a  thorough  cleaning,  and  later  on 
to   frequent  disinfection.    If  possible,   the  patient 


1^6 


should  be  transferred  for  about  an  hour  during  this 
process  to  another  room  already  cleaned  and  aired. 
Meanwhile  all  the  windows  of  the  sick-room  are  to 
be  opened  as  widely  as  possible  in  order  to  effect  an 
energetic  ventilation.  The  bed  must  then  be  taken 
completely  apart  and  the  mattresses,  pillows,  and 
bed-clothing  either  renewed  or  turned,  or  at  any  rate 
thoroughly  and  individually  aired. 

None  but  light  blankets  should  be  used  as  a  cov- 
ering for  the  sick.  Weak  patients  are  invariably 
distressed  by  the  weight  of  bed-clothing,  which 
often  prevents  sound  sleep.  The  bed  should  not 
stand  too  high  to  allow  of  the  patient's  leaving  it  and 
moving  about,  when  the  physician  permits.  It 
should  not  be  placed  in  a  corner,  but  should  stand  as 
nearly  as  possible  in  the  middle  of  a  large  room,  so 
that  the  patient  shall  receive  air  and  softer  light  di- 
rectly from  their  sources.  Bed-curtains  are  accord- 
ingly inadmissible. 

If  possible,  the  sick-chamber  should  be  that  room 
in  the  house  into  which  the  Sunshine  has  the  readiest 
entrance;  and  if  the  bed  can  be  so  placed  that  its 
occupant  sees  a  stretch  of  blue  sky,  so  much  the 
better  will  it  be.  If  the  patient  can  see  out  of  two 
windows  instead  of  one,  he  will  be  twice  as  well  off. 
It  is  found  in  all  hospitals  that  rooms  which  admit 
the  sunlight  have  fewer  deaths,  all  other  things  con- 
sidered, than  those  upon  the  shady  side  of  the  build- 


m 

mg;  and,  where  statistics  have  been  kept  for  a 
period  of  years,  it  is  found  that  the  average  time 
for  recovery  is  earher  upon  the  sunny  side  than  upon 
the  shady.  Farthermore,  it  has  been  shown  that 
in  asylums,  prisons,  and  other  institutions  more 
of  the  inmates  become  ill  who  are  compelled  to 
reside  upon  the  shady  side  of  the  building  than  of 
those  who  live  on  the  sunny  side.  The  intelligent 
reader  will  remember  the  sad  variety  of  idiocy, 
called  "  cretinism,"  which  is  found  so  commonly 
upon  the  sides  of  deep  valleys  in  Switzerland,  where 
the  sun  has  no  freedom  of  access;  a  form  of  mental 
disease  wholly  unknown  upon  the  opposite  sides  of 
such  valleys,  more  favored  by  the  sunlight.  These 
statements  plainly  demonstrate  the  value  of  sun- 
shine, and  he  must  indeed  be  very  unwise,  who  neg- 
lects to  apply  his  knowledge  of  its  importance  to  the 
affairs  of  everyday  life.  There  are  a  few  diseases, 
such  as  certain  affections  of  the  eye  or  brain,  in 
which  a  subdued  light  is  required  for  a  time.  But 
even  in  these  a  room  on  the  sunny  side  of  the  house, 
with  suitable  curtains  at  the  windows,  is  usually  to 
be  preferred  to  one  upon  the  shady  side. 

A  sick  person  should  never  under  any  circum- 
stances be  awakened  from  sleep  without  the  sanction 
of  the  physician.  Once  awakened  after  a  short  nap, 
a  patient  can  rarely  fall  asleep  again ;  while,  had  he 
slept  a  few  hours  before  being  aroused,  he  might  have 


n§ 


fallen  asleep  again  in  a  few  minutes  with  little 
effort. 

As  a  rule  Visitors  should  be  excluded,  and  only 
those  admitted  who  are  congenial  to  the  patient  and 
whose  pleasant  and  friendly  faces  seem  therefore  to 
exercise  a  beneficial  influence  over  him.  In  like 
manner  he  should  be  surrounded  only  by  agreeable 
objects,  such,  for  instance,  as  his  favorite  flowers. 
For  protection  from  the  annoyance  of  flies  and  Mos- 
quitoes screens  should  be  used  in  spite  of  their  slight 
interference  with  ventilation.  If  other  measures  are 
found  necessary  against  mosquitoes,  an  effective  prep- 
aration may  be  supplied  in  the  balsamic  ^'  essence  of 
pennyroyal,"  a  vial  of  which  is  to  be  left  hanging 
Uncorked  above  the  bed.  The  pain  and  redness  of 
the  skin  which  result  from  the  bite  of  a  mosquito 
disappear  at  once  upon  the  application  of  spirits  of 
ammonia,  or,  still  better,  of  the  anisated  spirits  of 
anunonia. 

Noises,  and  especially  startling  noises,  ought  most 
carefully  to  be  guarded  against,  A  good  nurse  will 
see  that  no  door  opens  with  a  creak,  that  no  window 
rattles,  and  a  very  good  one  will  also  make  sure  that 
not  even  a  curtain  flaps.  A  drop  of  oil  and  a  feather 
may  be  relied  on  to  do  away  with  the  creaking. 

A  sick  person  never  should  be  subjected  to  curi- 
osity, anxiety,  care,  sorrow,  or  any  form  of  fear.  As 
a  rule  business  matters  should  not  be  discussed  in  the 


m 


presence  of  the  sick.  Sometimes  a  man  who  ha^ 
made  no  will  before  his  illness  is  anxious  and  uneasy 
until  that  duty  is  accomplished,  but  takes  a  favorable 
turn  as  soon  as  the  matter  is  off  his  mind.  The  less 
mental  effort  demanded,  the  better  for  the  patient. 

It  is  the  Duty  of  a  Nurse,  both  in  his  own  inter- 
est and  in  that  of  his  charge,  to  avoid  every  form  of 
activity  prejudicial  to  his  health,  every  diminution 
of  his  strength,  and  every  possibility  of  contagion. 
For  the  latter  reason  he  should  be  careful  never  to 
approach  the  bed  of  a  patient  sick  with  contagious 
disease,  when  his  own  stomach  is  empty  ;  for  such  a 
stomach  predisposes  greatly  to  contagion.  He  should 
wear  no  beard,  should  keep  his  hair  cut  short,  should 
bathe  and  disinfect  his  person  frequently,  and  should 
often  change  his  hnen  and  outer  clothing.  The  latter 
should  be  light  rather  than  dark  in  color.  The  nurse 
should  not  approach  the  sick-bed  upon  the  side  re- 
moved from  an  open  window,  in  order  that  the  en- 
tering air  may  not  have  an  opportunity  of  reaching 
him  across  the  bed.  He  should  never  raise  a  bed- 
covering  from  his  own  side  of  the  bed,  but  always 
from  the  opposite  side,  reaching  across  the  patient, 
in  order  not  to  expose  himself  to  the  first  outburst  of 
contaminated  air  confined  beneath  the  fabric.  In 
cases  of  contagious  disease  neither  the  nurse  nor 
any  other  person  ought  to  be  allowed  to  make  use  of 
any  article  used  by  the  patient.     In  certain  conta- 


180 


gloiis  diseases,  moreover,  every  one  who  approaches 
the  patient  should  wear  a  respirator  before  his 
mouth  and  nose,  for  this  precaution  insures  protec- 
tion by  compelling  the  air  inhaled  to  pass  through  a 
layer  of  cottonwool,  which  absorbs  all  germs  of  dis- 
ease. But  a  person  so  protected,  while  himself 
escaping  infection,  is  quite  capable  of  spreading  the 
disease  by  means  of  his  clothing,  and  he  should  not 
fail  to  disinfect  himself  thoroughly  as  soon  as  he 
leaves  the  patient.  This  warning  refers  especially 
to  persons  leaving  crowded  institutions  where  con- 
tagious diseases  are  rife,  such  as  schools,  camps, 
prisons,  ships,  and  hospitals. 

A  judicious  physician  will  limit  the  amount  of 
Medication  to  the  smallest  possible  quantity.  On  the 
other  hand  it  is  the  part  of  wisdom  for  the  patient  to 
follow  carefully  the  doctor's  instructions  and  to 
aVoid  any  offence  against  his  commands.  Many 
drugs  are  poisons,  and  the  patient  may  under  no 
circumstances  increase  the  dose  his  physician  has 
ordered,  in  the  belief  that  a  larger  quantity  of  the 
drug  will  bring  him  quicker  relief.  Not  only  do 
such  capricious  acts  sometimes  prove  dangerous  and 
even  fatal  to  the  patient,  but  they  have  in  other  in- 
stances precisely  the  opposite  effect  from  that  in- 
tended for  the  drug,  for  many  substances  act  in 
quite  a  different  way  when  taken  in  overdoses  from 


181 


what  they  do  when  administered  according  to  du-ec- 
tions. 

A  disposition  is  often  seen  to  purchase  medicines 
wherever  thej  can  be  obtained  at  the  lowest  price. 
This  course,  however,  is  always  an  unwise  one,  as  the 
education  of  the  purchaser  does  not  permit  him  to 
judge  of  the  purity,  strength,  or  efficiency  of  the 
drug.  Medicines  should  invariably  be  bought  of  the 
most  reliable  druggist.  What  is  left  unused  of  pre- 
scriptions ordered  by  a  physician  should  not  be  pre- 
served, as  there  is  not  one  chance  in  a  hundred  that 
the  same  special  combination  will  ever  be  required 
again,  unless  in  the  case  of  some  liniment  or  some 
constituent  of  one  which  can  be  utilized  in  some  way. 
Beside  this,  medicines  as  a  rule  do  not  keep  well,  and 
the  more  bottles  of  this  sort  to  be  found  about  the 
house,  the  greater  is  the  likelihood  of  a  mistake  in 
getting  hold  of  one  when  another  is  wanted.  When 
not  in  immediate  use  all  medicines  should  be  kept  in 
a  separate  closet  or  in  some  other  well-determined 
repository.  Such  place  of  storage  should  be  wholly 
free  from  dampness,  for  moisture  impairs  and  grad- 
ually destroys  the  efficacy  of  most  drugs,  especially 
when  in  the  form  of  powders.  If  the  closet  can  be 
kept  under  lock  and  key,  so  much  the  better.  Light 
must  be  excluded,  as  it  destroys  many  substances. 
A  low,  uniform  temperature  is  likewise  desirable. 


182 


Pills  kept  for  some  time  become  so  hard  that  they 
are  not  more  soluble  in  the  stomach  than  grains  of 
coffee.  This  is  especially  true  of  sugar-coated  pills, 
but  the  objection  may  be  overcome  by  enclosing  the 
number  to  be  taken  at  a  dose  in  a  piece  of  muslin 
and  reducing  them  to  fragments  by  a  blow. 

The  most  dangerous  persons  about  a  patient  are 
the  old  (and  in  not  a  few  instances,  too,  the  young) 
aunts  and  grandmothers  of  either  sex,  who  are  often 
the  more  importunate  with  their  panaceas,  the  less 
they  understand  about  the  matter.  Such  individuals 
would  do  better,  instead  of  vaunting  the  infallibility 
of  their  preparations  in  every  known  ailment,  to  ex- 
amine into  their  own  conduct,  and  to  confess,  in  the 
light  of  their  age  and  past  experiences,  that  they  are 
assuming  an  unwarrantable  responsibility  by  inter- 
fering with  and  often  by  completely  neutralizing  the 
physician's  treatment.  Nowhere  has  the  saying, 
"  Deliver  me  from  my  friends,"  a  truer  application 
than  here.  Often,  indeed,  there  is  less  of  friendship 
and  sympathy  than  of  self-love  and  vanity  in  the 
motives  which  prompt  this  usurpation  of  the  heaHng 
office.  While  a  physician  takes  pains,  in  the  state- 
ment of  his  diagnosis  and  prognosis,  to  be  tender, 
sparing,  and  considerate,  these  obtrusive  meddlers, 
in  order  to  stand  afterward  in  so  much  the  better 
light,  Tie  in  setting  forth  the  patient's  condition  in 


183 


gloomy,  unconsoling  colors,  thereby  greatly  depress- 
ing his  mental  and  bodily  powers  of  resistance. 
Still,  the  more  reprehensible  their  conduct,  the  less 
risk  is  there  for  them  :  if  the  patient  recovers,  they 
take  the  credit ;  if  his  sickness  assumes  a  serious 
turn,  it  is  the  doctor's  fault. 

On  the  other  hand,  much  depends  upon  the  influ- 
ence of  sympathetic  clergymen  and  truly  considerate 
friends,  who  have  it  in  their  power  to  set  quite  at 
ease  the  devout  and  trustful  spirit  of  an  invalid. 
This  indirect  assistance  is  of  great  value,  for  no  phy- 
sician, to  whatever  quarter  his  religious  belief  may 
incline,  will  deny  that  a  patient's  recovery  may  be 
materially  hastened  by  favorable  mental  influences. 

Clergymen  and  school  teachers  in  country  dis- 
tricts where  no  physician  is  at  hand  would  do  well 
to  possess  themselves,  like  captains  of  vessels,  of  a 
certain  amount  of  medioal  knowledge,  in  order  to  be 
able  in  emergencies  to  render  the  earliest  and  most 
necessary  aid  without  waiting  for  the  doctor's  arri- 
val. With  the  same  object  a  small  stock  of  medicines 
should  also  be  kept  at  hand,  whose  composition  and 
uses  have  been  explained  by  a  neighboring  prac- 
titioner. 


184 


THE  FAMILY  PHYSICIAN. 

The  head  of  a  family  displays  his  intelligence  as 
well  as  his  paternal  love  and  solicitude  by  a  proper 
appreciation  and  a  timely  and  judicious  employmer  t 
of  a  skillful  physician.  When  in  doubt  as  to  the 
need  of  a  physician,  it  is  safest  to  call  one,  and  so  to 
quiet  both  conscience  and  anxiety.  The  physician 
should  not  be  changed,  but  choice  should  be  made  at 
the  outset  of  a  skillful,  reliable  practitioner,  whom 
henceforth  the  family  should  employ  upon  all  occa- 
sions, in  whom  the  fullest  confidence  should  be  re- 
posed, from  whom  nothing  should  be  concealed,  and 
who  should  be  entrusted  with  all  the  secrets  of  the 
household ;  for  the  doctor,  like  a  good  general,  must 
possess  an  accurate  knowledge  of  the  whole  field. 
It  is  a  good  plan  to  agree  with  the  family  physician 
concerning  a  definite  yearly  compensation  not  too 
scanty  in  amount,  for  such  an  arrangement  offers 
security  that  he  will  exercise  strict  vigilance  in  pre- 
ventive sanitation,  and  that  he  will  promptly  allay 
the  first  symptoms  of  a  disease,  or  at  least  moderate 
its  course  so  far  as  possible. 

The  eye  of  a  physician  excels  even  a  mother's  in 
acuteness,  and  frequently  discovers  threatening  evils 
which  have  escaped  the  latter.    Not  infrequently  it 


185 


happens  that  a  disease  has  taken  root  without  so 
much  as  a  misgiving  upon  the  part  of  the  individual 
affected.  This  shows  the  advisability,  even  for  those 
who  consider  themselves  well,  of  submitting,  once  or 
twice  each  year,  to  examination  by  a  conscientious 
physician.  Still  farther,  the  preventive  skill  of  the 
physician  should  be  invoked  in  regard  to  the  build- 
ing of  a  house  or  the  hiring  of  one,  the  hygienic 
arrangements  of  the  dwelling,  the  apparatus  for 
heating  and  lighting,  ventilation,  diet,  the  selection 
of  a  wet-nurse,  the  climate  of  a  location,  the  educa- 
tion of  children,  the  selection  of  a  calling,  the  ques- 
tion of  matrimony. 

On  the  other  hand  it  is  the  perpetual  duty  of  the 
physician,  in  whose  hands  lies  so  largely  the  fate  of 
families  and  of  communities,  to  study  exhaustively, 
and  to  keep  himself  well  informed  throughout  his 
whole  life,  in  all  matters  of  scientific  medical  prac- 
tice. The  life  of  a  conscientious  physician,  whether 
he  have  much  or  little  practice,  is  an  almost  cease- 
less alternation  between  hours  of  attendance  upon 
patients  and  hours  of  study.  It  is  not  to  be  wondered 
at,  in  view  of  their  enormous  bodily  and  mental  ex- 
ertions, as  well  as  their  sacrifices,  that  physicians  do 
not  belong  to  the  long-lived  classes,  even  if  we  omit 
to  consider  their  exposure  to  contagious  diseases. 
The  physician,  therefore,  is  entitled  to  claim,  not 


186 


merely  a  liberal  compensation,  but  also  the  fullest 
gratitude  and  veneration.  Whoever  makes  easier  to 
physicians  and  to  medical  students  either  the  pecun- 
iary or  the  mental  struggle  of  life,  whoever  ^*  strews 
roses  on  their  paths,"  deserves,  not  only  from  them, 
but  from  all  mankind,  to  whom  the  doctor  is  called 
to  minister,  the  sincerest  thanks.  Especially  should 
philanthropists  appreciate  this  well-meant  appeal, 
and  contribute  freely  to  the  establishment  and  main- 
tenance of  medical  institutions  of  various  classes. 


HOW  TO  GIVE  AID  IN  EMERGENCIES. 


I  In  considering  the  treatment  of  the  sick  we  de- 
sign to  lay  stress  especially  upon  measures  of  relief 
in  cases  of  accident  and  sudden  illness,  when  life  is 
often  jeopardized  by  a  failure  to  render  immediate 
aid.  Our  object  will  be  to  place  the  intelligent  lay- 
man in  such  a  position  as  will  enable  him  in  cases  of 
emergency  to  render  the  earliest  efl&cient  assistance. 
This  we  would  do  without  in  the  remotest  degree 
depreciating  the  services  of  the  physician,  for,  even 
if  the  patient  has  been  relieved  before  the  doctor 
arrives,  still,  further  treatment  is  always  found  in- 
dispensable. In  other  diseases,  however,  where 
there  is  no  danger  in  a  moderate  delay,  we  restrict 
ourselves  to  a  short  hygienic  and  dietetic  summary, 
leaving  the  main  points  of  treatment  to  the  attend- 
ing physician. 

The  occurrence  of  an  accident  in  any  well-pop- 
ulated region  is  sure  to  draw  a  crowd  about  the 
victim.  The  first  thing  to  be  done  is  to  disperse 
such  a  gathering,  or  at  least  to  persuade  spectators 
to  ke^  away  from  the  injured  person.    A  space  of 

187 


188 


not  less  than  ten  feet  on  every  side  should  be  com- 
pletely cleared,  only  those  being  allowed  to  approach 
nearer  who  are  in  immediate  charge  of  the  opera- 
tions for  relief.  In  most  cities  appliances  for  carry- 
ing injured  persons  are  required  to  be  kept  at  police 
stations,  and  can  be  obtained  on  application,  as  well 
as  the  services  of  a  good  policeman.  The  authority 
of  the  latter  is  almost  invaluable  in  keeping  back 
the  crowd  and  in  securing  useful  attention  while  con- 
veying the  injured  individual  through  the  streets. 

Fainting.  When  anyone  faints  he  should  be 
placed  in  a  recumbent  position,  with  his  head  low, 
if  he  is  pale  and  bloodless,  but  high,  if  red  in  the 
face,  and  every  tight-fitting  garment  should  be 
loosened.  Then  he  should  be  fanned  in  the  open  air 
or  by  an  open  window,  cold  water  should  be  sprin- 
kled over  him,  and  his  temples  bathed  with  vinegar, 
ether,  or  cologne,  while  ammonia,  burnt  feathers,  or 
singed  hair  are  held  beneath  his  nose,  and  his  nos- 
trils are  tickled  to  make  him  sneeze.  If  the  faint 
be  a  deep  one,  an  enema  of  vinegar  may  be  admin- 
istered, the  feet  and  hands  bathed  in  warm  water, 
the  soles  of  the  feet  chafed,  and  mustard  applied 
over  the  heart.  Upon  coming  out  of  the  faint  the 
patient  should  still  preserve  for  a  time  the  reclining 
or  recumbent  position,  and  should  drink  a  little  cold 
water,  some  brandy  and  water  in  the  proportion  of 
a  teaspoonful  of  brandy  in  a  tablespoonful  of  water, 


189 


or  a  little  aromatic  spirits  of  ammonia,  ten  drops 
every  few  minutes  in  a  tablespoonful  of  water. 

A  Trance  is  the  most  extreme  form  of  fainting, 
and  the  appearance  of  a  person  in  a  trance  resembles 
very  closely  that  of  one  dead.  Only  a  layman,  how- 
ever, can  make  a  mistake  in  this  respect,  certainly 
not  a  physician  trained  in  scientific  accuracy  and  in 
careful  methods  of  examination  ;  for  such  an  exam- 
ination soon  makes  it  apparent  that  both  heart- 
sounds,  or  at  least  one  of  them,  can  be  heard  in  a 
lethargic  person,  although  sometimes  very  faint  and 
infrequent.  If  heard  less  frequently  than  once  in 
Rve  minutes,  the  condition  must  be  that  of  death. 
Another  evidence  of  death  may  be  found  in  the  eyes, 
which  present  a  dry  and  wrinkled  appearance  of  the 
conjunctiva  and  cornea.  The  condition  of  the  skin 
may  be  tested  by  rubbing  it  with  a  cloth  dipped  in 
caustic  ammonia  until  the  epidermis  or  outer  layer 
has  been  removed  :  in  a  dead  person  the  eroded  spot 
will  dry  Uke  parchment,  while  in  a  lethargic  it  will 
become  moist  and  red.  Accurate  proof  of  death,  if  it 
exists,  may  be  obtained  by  thrusting  a  fine  aspirat- 
ing needle  into  the  heart  muscle  between  the  fifth 
ana  sixth  ribs,  an  experiment  attended  by  no  danger 
when  the  needle  is  not  inserted  too  deeply.  The 
shghtest  motion  of  the  heart  will  then  be  detected 
from  the  quivering  imparted  by  it  to  the  projecting 
portion  of  the  needle.     The  surest  test  for  a  layman 


190 


is  decomposition,  which  begins  with  a  bad  odor  and 
with  green  spots  upon  the  skin.  Trials  with  electri- 
cal apparatus  are  unsatisfactory,  unsafe,  and  ought 
never  to  be  made. 

The  signs  of  revival  from  a  trance  are  a  slight 
increase  of  warmth  about  the  heart,  the  blurring  of 
a  mirror  held  before  the  mouth,  the  trembling  of  a 
feather  in  the  'breath,  sensitiveness  and  contraction 
of  the  pupils  when  approached  by  a  light,  reddening 
of  the  skin  when  chafed,  slight  movements  of  the 
muscles  of  the  face  and  eyelids,  a  gradual  strength- 
ening of  the  pulse  and  heart-beat,  together  with  a 
slight  rising  and  sinking  of  the  chest,  best  seen  when 
a  glass  of  water  is  set  upon  it.  To  avoid  burial  dur- 
ing life  the  most  serviceable  measures  are  the  pro- 
hibition of  premature  interments,  the  allowing  of 
interment  only  after  the  beginning  of  decomposi- 
tion or  after  an  autopsy,  and  the  careful  determina- 
tion of  death  by  medically  competent  persons. 

The  treatment  of  an  individual  apparently  dead 
should  be  begun  by  freeing  him  from  every  injuri- 
ous influence,  such  as  ribbons  about  the  neck,  nox- 
ious gases,  and,  in  the  case  of  those  nearly  drowned, 
from  water  in  the  air-passages.  This  accomplished, 
he  should  be  placed  in  a  room  filled  with  fresh  air, 
his  clothing  removed  cautiously  but  as  quickly  as 
possible,  by  cutting  it  off,  if  necessary,  his  mouth 
and  nose  cleared  of  any  obstruction,  and  an  effort 


191 


made  to  restore  his  nervous  energy,  his  circulation, 
and  above  all  his  respiration.  This  maybe  accom- 
plished by  making  warm  applications  to  the  body 
and  by  warm  baths,  by  washing  the  skin  with  vine- 
gar, by  rubbing,  brushing  and  kneading  it  vigorously, 
by  tickhng  the  nose  and  throat,  by  rousing  the  nerve 
of  smell  with  irritants  such  as  spirits  of  ammonia, 
by  dropping  naphtha  and  spirits  of  mustard  upon  the 
prsecordia,  or  by  applying  a  mustard  poultice  in  the 
same  region.  Especial  benefit  may  be  derived  from 
artificial  respiration  and  from  blowing  air  into  the 
lungs.  If,  in  effecting  the  latter,  the  operator  would 
avoid  applying  his  mouth  to  that  of  the  patient,  let 
him  apply  a  funnel,  bladder,  or  other  tube.  During 
the  inspiration  the  nose  of  the  patient  must  be  kept 
closed.  After  the  lungs  have  been  filled  with  air, 
the  chest  and  abdomen  are  to  be  pressed  upon  and 
the  air  expelled,  or  the  patient  may  be  rolled  upon 
his  back  and  chest  alternately.  It  is  often  sufficient 
to  compress  the  abdomen  between  the  palms  of  the 
hands,  in  order  to  press  upward  the  diaphragm  and 
lungs  and  so  to  expel  the  air  forcibly.  Then,  when 
the  hands  are  withdrawn,  the  diaphrag-m  returns  to 
its  former  position,  and  air  is  drawn  into  the  lungs 
again.  In  persons  in  this  condition  artificial  respi- 
tion  should  be  maintained  for  at  least  four  or  five 
hours,  the  face,  chest,  and  back  being  sprinkled 
meanwhile  at  intervals  with  cold  water. 


192 


Upon  the  revival  of  the  patient  the  efforts  for  his 
restoration  should  be  remitted  at  times,  but  they 
should  be  continued  gently  with  intermissions  until 
ids  complete  return  to  consciousness.  Wine  should 
be  administered,  if  possible,  at  this  stage  as  a  resto- 
rative. If  sleep  occurs  or  perspiration  breaks  out, 
care  should  be  taken  not  to  interfere  with  them. 

When  every  effort  at  resuscitation  proves  ineffec- 
tual, the  unfortunate  should  be  wiped  quite  dry,  and 
covered  with  a  cloth,  his  head  being  allowed,  how- 
ever, to  remain  uncovered.  He  should  be  placed  in 
a  warm  room,  where  he  should  be  kept  under  obser- 
vation until  the  signs  of  death  appear.  This  latter 
precaution  is  necessary,  because  sometimes  it  hap- 
pens that  a  person  does  not  come  out  of  his  lethargy 
until  the  efforts  for  his  recovery  have  been  sus- 
pended and  he  finds  himself  alone  and  in  quiet. 

The  most  practical  method  of  reviving  Persons 
Nearly  Drowned  is  that  of  Marshall  Hall.  The  sub- 
merged man  must  be  removed  from  the  water  gently, 
any  roughness  in  shaking,  rolling,  or  tossing  the  head 
about  being  especially  avoided.  The  nose,  mouth, 
and  pharynx  should  at  once  be  cleansed  carefully 
from  mud,  sand,  and  water.  It  is  also  a  good  plan 
to  tickle  the  throat  with  a  feather  in  order  to  in- 
duce vomiting,  thus  emptying  the  stomach  and 
lungs  of  foreign  material.  The  unfortunate  indi- 
vidual should  then  be  laid  without  delay  upon  his 


1^3 


chest  with  one  arm  beneath  his  forehead.  Both 
hands  of  the  operator  are  then  to  be  pressed  hghtly 
upon  his  back,  so  as  to  eject  the  water  from  his 
larynx  and  a  part  of  the  air  from  his  lungs.  His 
body  is  then  to  be  repeatedly  rolled  over  slowly 
upon  the  shoulder  whose  arm  lies  beneath  his  fore- 
head, or  even  a  little  farther  over,  and  at  once 
quickly  returned  upon  the  face.  By  means  of  this 
procedure  the  process  of  respiration  is  again  insti- 
tuted. Gradually  the  heart  begins  to  beat  more 
strongly  and  more  frequently;  blood  rich  in  oxygen 
flows  to  the  brain  and  spinal  cord,  and  through  the 
revival  of  these  organs  the  whole  body  returns  to 
its  former  condition. 

This  restoration  should  be  effected  very  quietly, 
without  precipitation  and  without  rude  violence. 
The  patient  should  not  be  made  to  breathe  oftener 
than  sixteen  times  in  a  minute,  which  is  the  fre- 
quency of  normal  respiration.  If  possible,  his  limbs 
should  be  briskly  rubbed,  for  this  excitation  has  a 
restorative  action  upon  the  skin.  Wet  clothing 
should  early  be  replaced  by  dry.  The  duration  of 
artificial  respiration  is  to  be  regulated  by  the  neces- 
sity of  the  case.  When  the  individual  has  been 
less  than  five  minutes  under  water,  artificial  may 
be  immediately  followed  by  natural  respiration  :  in 
other  instances  life  is  restored  only  after  thirty  or 
forty  minutes  of  continuous  artificial    respiration. 


194 


Even  when  submerged  persons  have  been  as  long 
as  twenty  minutes  in  the  water,  success  has  some- 
times been  attained  in  restoring  them  to  Hf e.  This 
method  is  adapted  not  only  to  the  revival  of  persons 
apparently  drowned,  but  also  to  that  of  persons  in  a 
state  of  suspended  animation  after  hanging,  after 
the  inhalation  of  carbonic  acid,  illuminating  gas,  or 
chloroform,  and  under  other  circumstances. 

Still  more  effective,  it  appears,  is  artificial  respir- 
ation according  to  the  Method  of  Dr.  Sylvester.  By 
this  method  the  patient  is  to  be  laid  upon  his  back 
upon  a  gentle  incline,  in  such  a  way  that  his  head 
shall  lie  a  little  higher  than  his  feet,  and  a  small,  firm 
cushion  is  to  be  placed  beneath  his  head  and  shoul- 
ders, or,  in  its  absence,  a  folded  garment.  Next,  his 
tongue  should  be  drawn  forward  and  secured  beyond 
his  lips.  For  this  purpose  the  most  serviceable  ap- 
pliance is  an  elastic  band  fastened  over  the  tongue 
and  under  the  chin.  The  operator,  standing  behind 
the  patient's  head,  should  then  grasp  the  arms  of  the 
latter  just  above  the  elbows  and  draw  them,  with  a 
gentle,  steady  motion,  to  a  position  of  extension 
above  the  head.  Here  they  are  to  be  held  for  about 
two  seconds,  while  air  is  allowed  to  enter  the  lungs 
freely.  The  arms  are  then  to  be  carried  downward 
and  pressed  gently  but  firmly  for  about  the  same 
length  of  time  against  the  sides  of  the  patient's  chest, 
in  order  to  expel  the  air  from  his  lungs.     These  mo- 


195 


tions  should  be  repeated  in  alternation  ten  times  in 
the  course  of  every  minute  until  a  continuous  respir- 
atory movement  becomes  perceptible.  When  this 
happens  artificial  respiration  may  be  discontinued 
and  an  effort  made  to  restore  the  warmth  and  circu- 
lation of  the  body. 

A  special  apparatus  for  artificial  respiration  may 
sometimes  be  found  of  service.  It  establishes  arti- 
ficial respiration  by  introducing  condensed  air  into 
the  lungs  and  withdrawing  it  again  by  means  of 
bellows. 

In  speaking  of  the  restoration  of  submerged  per- 
sons we  would  advert  to  the  remark  so  often  made  of 
such  individuals,  ''he  was  a  good  swimmer,  and 
must  have  been  attacked  with  cramps."  The  refer- 
ence is  to  a  spasmodic  contraction  of  the  muscles, 
beyond  the  control  of  the  individual,  which  occurs 
after  exhaustion  of  a  muscle  from  over-exertion. 
Persons  suffering  from  debility,  especially  the  de- 
bility peculiarly  affecting  the  nervous  system,  should 
never  be  induced  to  go  beyond  depth  in  the  water  or 
out  of  reach  of  immediate  assistance.  There  is  no 
warning  in  advance  of  the  seizure,  and  the  unfortu- 
nate individual  sinks  at  once.  Many  lives  are  every 
sunmier  lost,  in  shallow  as  well  as  in  deep  water, 
from  these  seizures,  which  might  have  been  avoided, 
had  the  bather,  who  is  perhaps  just  recovering  from 
an  attack  of  sickness,  not  neglected  the  above  precau- 


106 


tions.  A  farther  word  of  caution  to  those  in  danger 
of  drowning,  whom  presence  of  mind  may  enable  to 
preserve  their  lives.  Throwing  up  the  hands  serves 
only  to  expel  the  air  from  the  lungs,  and  so  to  lessen 
the  period  during  which  a  stay  under  water  can  be 
endured.  On  the  contrary,  he  who,  upon  finding 
himself  overwhelmed,  places  his  arms  beside  his 
body  and  quietly  husbands  his  stock  of  air,  is  far 
more  likely  to  be  resuscitated  by  the  rescuers. 

Attention  to  the  following  rules  will  prove  of  ser- 
vice to  the  rescuer  in  cases  of  accident:  (1.)  Before 
jumping  into  the  water,  remove  rapidly  as  much  of 
your  clothing  as  possible :  if  there  is  no  time  to  do 
so,  this  preparation  may  be  omitted,  but  in  any  event 
remove  your  shoes  from  your  feet,  for  they  will  fill 
with  water  and  so  impede  your  swimming;  (2.)  do 
not  seize  hold  of  a  drowning  man  so  long  as  he 
struggles  in  the  water,  but  wait  a  moment  until  he 
is  quiet :  it  is  foolhardy  to  take  hold  of  a  person  who 
is  fighting  with  the  waves,  and  whoever  does  it  sub- 
jects himself  to  great  risks;  (3.)  when  the  unfortunate 
becomes  quiet,  approach  him  and,  seizing  him  by  the 
hair,  turn  him  as  quickly  as  possible  upon  his  back 
and  give  him  a  gentle  push  to  keep  him  up :  then 
turn  upon  your  own  back,  and  in  this  manner  swim 
to  land,  holding  the  inanimate  person's  hair  with 
both  hands,  and  his  head,  face  upward  of  course, 
upon  your  abdomen;  (4.)  if  the  drowning  man  has 


197 


sunk  to  the  bottom,  the  place  where  his  body  lies 
may  be  known  in  quiet  water  by  the  air-bubbles 
which  occasionally  rise  to  the  surface;  (5.)  if  you 
succeed  in  finding  the  body  by  diving,  seize  it  with  one 
hand  by  the  hair,  and  use  your  other  hand  and  your 
feet  to  swim  to  the  surface;  (6.)  on  the  ocean  it  is 
very  foolish  to  try  to  reach  land  when  a  current  sets 
offshore :  it  is  better  to  turn  upon  one's  back,  no  mat- 
ter whether  alone  or  burdened  with  the  body  of  an- 
other, and  so  to  float  until  help  arrives. 

A  drowned  person  dies  of  suffocation.  He  in- 
spires water  instead  of  air  into  his  lungs,  and  so 
takes  in  a  large  amount  of  water.  Death  from  suffo- 
cation does  not  take  place  at  once,  but  only  after  a 
prolonged  struggle  with  the  waves.  A  drowned  per- 
son presents  the  appearance  of  one  who  has  died  of 
suffocation — face  purple  and  swollen,  lips  purple, 
eyes  bloodshot;  upon  opening  the  mouth,  a  frothy 
fluid  exudes;  and  the  stomach,  windpipe,  and  lungs 
are  also  full  of  water. 

Sometimes,  however,  the  appearances  are  very 
different.  The  face  is  pale  and  flabby,  and  little 
water  is  found  in  the  mouth,  or  at  least  no  froth. 
These  are  indications  that  death  has  not  occurred 
from  suffocation,  but  that  a  fit  of  fainting  or  a  stroke 
of  apoplexy  has  taken  place.  In  this  event  it  may 
be  supposed  that  the  movements  of  the  lungs  have 
ceased  immediately,  and  that  the  glottis,  the  entrance 


198 


of  the  windpipe,  has  closed  spasmodically,  so  that 
little  or  no  water  can  enter.  This  appearance  is 
favorable,  for  under  these  circumstances  the  prospect 
of  restoring  life  is  far  better  than  under  those  first 
described. 

Persons  Suffocated  by  carbonic  acid,  carbonic 
oxide,  illuminating  gas,  or  sewer  gas  must  be  re- 
moved  as  quickly  as  possible  to  a  room  where  the  air 
is  pure  and  where  the  windows  and  doors  are  kept 
open  to  secure  a  constant  renewal  of  the  atmosphere. 
All  clothing  must  be  removed  as  rapidly  as  possible, 
and  the  patient,  completely  denuded,  placed  in  a  half- 
recumbent  position,  and  the  measures  already  de- 
tailed employed  to  restore  him  to  life.  If,  however, 
the  respiratory  movements  have  already  ceased, 
long-continued  artificial  respiration  can  alone  be 
expected  to  give  success. 

If  a  person  suffering  from  Carbonic  Acid  Poi- 
soning was  prostrate  at  the  time  the  gas  was  in- 
haled, he  may  be  inferred  to  hav^  drawn  a  larger 
quantity  of  it  into  his  lungs  than  if  standing.  For, 
being  heavier  than  the  atmosphere,  much  more  of 
the  gas  is  to  be  found  at  the  bottom  of  a  well  or 
cavern  than  five  feet  higher  up.  In  illustration  of 
this  fact  we  may  cite  the  so-called  "  dogs' grotto " 
near  Naples,  a  cave  containing  carbonic  acid  gas,  in 
which  dogs  die,  but  not  men.  No  well,  vat,  old 
cellar^  or  cavern  of  any  kind  should  ever  be  entered 


199 

without  a  lighted  candle  being  first  lowered  to  its 
farthest  depth.  If  the  flame  is  extinguished,  or  if  it 
burns  dimly,  indicating  in  this  way  the  presence  of 
carbonic  acid  gas,  no  one  should  under  any  circum- 
stances be  permitted  to  enter  unless  the  foul  air  has 
been  removed.  It  is  not  so  heavy,  however,  that  a 
strong  current  of  atmospheric  air  will  not  readily 
dislodge  it,  and  it  may  be  rapidly  absorbed  by  means 
of  freshly  slaked  lime. 

When  a  person  is  overcome  by  carbonic  acid  gas, 
he  is  of  course  wholly  unable  to  help  himself,  and 
must  at  once  be  removed  by  another.  Sometimes  a 
grapnel  can  be  used  with  advantage,  but  often  the 
better  way  is  to  rapidly  lower  some  bold,  clear- 
headed individual,  with  a  rope  securely  fastened 
about  his  middle,  who  can  seize  the  unfortunate 
victim  and  bring  him  quickly  to  the  surface,  ^o 
time  should  be  lost  in  lowering  and  raising  the 
rescuer,  since  his  own  safety  as  well  as  that  of  the 
asphyxiated  person-depends  largely  upon  his  being 
able  to  do  all  that  is  necessary  during  the  interval 
for  which  he  can  hold  his  breath.  For,  of  course, 
should  he  inhale  the  gas  also,  his  situation  in  this 
respect  would  be  little  better  than  that  of  the  man 
he  was  attempting  to  succor.  A  large  sack  is  some- 
times thrown  over  the  head  and  shoulders  of  the 
rescuer :  this  contains  enough  air  to  serve  for  sev- 
eral inhalations,  while  the  texture  of  the  material 


200 


prevents  the  admission  of  the  gas  to  any  hurtful 
degree. 

The  asphyxiated  individual  should  be  stripped  of 
all  clothing  as  soon  as  he  reaches  the  free  air,  and, 
if  he  did  not  fail  into  water  upon  being  overpowered 
by  the  gas,  his  head,  neck,  and  shoulders  should  be 
freely  dashed  with  cold  water.  A  simple  sprinkling 
is  not  sufficient.  Some  one  should  stand  at  a  proper 
distance  with  a  bowl  of  water  in  his  hand,  and 
should  throw  its  contents  with  as  much  force  as 
possible  against  the  parts  named.  Others  should 
follow  in  rapid  succession  for  as  much  as  thirty 
seconds.  Then  the  dripping  water  should  be  wiped 
away  with  a  towel.  This  procedure  should  be  re- 
peated from  time  to  time  as  occasion  requires. 
Sometimes,  if  a  stream  of  running  water  is  at  hand, 
the  denuded  body  might  be  dipped  again  and  again, 
care  being  taken  that  the  face  remains  above  the 
surface.  Artificial  respiration  should  then  be  prose- 
cuted with  as  little  intermission  as  possible. 

If  the  patient  has  fallen  into  water  and  has  be- 
come chilled,  the  use  of  cold  water  in  this  manner  is 
to  be  avoided,  since  in  that  case  the  evaporation  of 
moisture  from  the  skin  is  likely  to  absorb  more  heat 
than  the  exhausted  system  can  supply.  In  this  event 
the  individual  should  be  placed  in  a  warm  bed  with 
hot  applications,  and  artificial  respiration  should  at 
once  be  established,  as  in  the  case  of  asphyxia  from 


201 


drowning  and  hanging.  While  artificial  respiration 
is  being  used  a  constant  friction  should  be  kept  up 
upon  the  limbs. 

Illuminating  Gas.  It  often  occurs,  when  the  gas 
has  been  ' '  turned  down  "  upon  retiring  at  night,  that 
the  flame  in  some  way  becomes  extinguished,  and 
that  enough  gas  escapes  to  give  trouble  to  the  sleeper 
unless  the  room  is  well  ventilated.  Persons  have 
also  been  known  to  blow  the  gas  out,  as  they  would 
a  candle,  and  more  or  less  complete  suffocation  has 
followed.  In  such  cases  the  treatment  required  is 
identical  with  that  of  asphyxia  from  the  inhalation 
of  carbonic  acid  gas. 

The  foul  air  which  exists  in  drains  and  privies 
usually  contains  a  large  proportion  of  Sulphuretted 
Hydrogen,  which  arises  from  the  decomposition  of 
the  residual  matters  always  found  there.  Great 
caution  on  this  account  should  always  be  observed 
in  opening  or  entering  such  places  or  any  place  in 
possible  communication  with  them,  especially  when 
long  closed.  A  small  quantity  of  pure  sulphuretted 
hydrogen,  if  inhaled,  usually  proves  fatal,  but  in  the 
cases  referred  to  the  gas  usually  exists  diluted  with 
common  air.  When  affected  by  this  gas,  the  breath- 
ing becomes  difficult,  the  individual  loses  his  strength, 
falls,  becomes  insensible  and  cold,  his  lips  and  face 
turn  blue,  and  his  mouth  becomes  covered  with  a 
secretion  of  bloody  mucus.     The  sufferer  should  be 


^oa 


removed  as  quickly  as  possible  beyond  the  influence 
of  the  foul  air,  and  treatment  pursued  as  directed  for 
carbonic  acid  poisoning. 

The  possibility  of  disaster  from  the  inhalation  of 
sulphuretted  hydrogen  should  always  be  borne  in 
mind  in  opening  long  closed  drains  or  privy  vaults, 
and  the  danger  lessened  by  dashing  into  the  cavity 
a  solution  of  a  few  pounds  of  chloride  of  lime  in  a 
pailful  of  water.  In  the  absence  of  the  chloride,  or 
"bleaching  salt,"  simple  lime  and  water  may  be 
employed  in  the  form  of  ordinary  "whitewash." 
This  gas  readily  combines  with  lime,  freeing  the  air 
to  that  extent  of  the  poisonous  compound. 

A  person  Struck  by  Lightning  should  quickly  be 
removed  from  the  scene  of  the  accident,  at  once  un- 
dressed and  placed  in  a  half -reclining  position,  and 
wrapped  in  warm  blankets.  After  this  is  done  the 
measures  of  revival  above  described  are  to  be  em- 
ployed, and  especially  that  of  artificial  respiration. 
Some  stimulant  should  be  administered,  a  teaspoon- 
ful  of  whiskey,  for  instance,  occasionally,  or  twenty 
drops  of  the  aromatic  spirits  of  ammonia  in  a  table- 
spoonful  of  water.  Burns  caused  by  lightning  should 
receive  the  same  attention  as  those  from  any  other 
cause.  Recoveries  are  on  record  after  an  hour  of 
suppose  death  from  lightning. 

Lightning  strikes  where  there  are  metals,  or 
where   water,    dampness,    or    evaporation    occurs. 


203 


Therefore  it  is  best  not  to  be  found  near  any  piece 
of  metal  during  a  storm,  and  not  to  take  refuge  in 
the  water  nor  under  a  tree.  Localities  where  there 
are  many  men  should  also  be  avoided. 

Sunstroke,  contrary  to  the  usual  impression,  is 
^  not  in  all  cases  due  to  exposure  of  the  head  to  the 
direct  rays  of  the  sun.  Statistics  shows  that  pros- 
tration from  the  effects  of  heat  may  occur  under 
shelter,  in  the  shade,  at  night,  or  even  in  persons 
who  have  not  been  exposed  to  the  sun  for  days 
before.  Intense  heat  need  not  be  solar,  but  may  be 
artificial.  Since  the  human  body  can  cool  itself 
much  more  readily  in  a  dry  than  in  a  moist  atmo- 
sphere, it  may  be  expected  to  resist  the  severities  of 
a  dry,  overheated  climate  more  easily  than  the  op- 
pressive closeness  of  a  damp  and  muggy  one.  For 
this  reason  sunstroke  is  much  more  infrequent  in 
the  dry  belt  of  the  Texan  prairies  than  in  the  low- 
lands of  India  or  upon  our  own  seacoast.  For  the 
same  reason  too  it  is  especially  prone  to  attack  in- 
door workers  in  confined,  moist  factories,  and  notably 
those  who  labor  in  laundries  and  sugar-refineries. 

Sunstroke  appears  to  be  decidedly  favored  by 
intemperance,  by  want  of  accHmatization,  and  by 
debility  following  fatigue  in  a  heated  atmosphere. 
^  Occupants  of  badly  ventilated  sleeping  apartments 
appear  to  be  oftener  affected  than  those  who  sleep 
in  purer  air. 


204 

It  is  generally  thought  by  non-professional  per- 
sons that  the  symptoms  of  sunstroke  come  on  with- 
out any  warning  whatever.    In  most  cases,  however, 
it  is  preceded  by  pain  in  the  head,  wandering  of  the 
thoughts  or  total  inability  to  think  at  all,  disturbed 
vision,  irritability  of  temper,  sense  of  pain  or  of 
weight  at  the  pit  of  the  stomach,  or  inability  to 
breathe  with  the  usual  ease  and  satisfaction.     These 
symptoms  become  more  and  more  marked  until  in- 
sensibility is  reached,  preceded  sometimes  by  delir- 
ium.   The  skin  grows  very  hot,  and  usually  very  dry, 
but  when  not  dry  is  covered  with  a  profuse  perspira- 
tion.    The  face  becomes  dusky,  or,  as  the  saying  is, 
blue.     Breathing  grows  rapid  and  short,  or  slow  and 
sighing.    The  action  of  the  heart,  as  felt  by  the  hand 
placed  over  it,  is  weak  and  rapid  and  often  as  tremu- 
lous as  the  ' '  fluttering  of  a  bird. "  In  many  instances, 
from  what  is  popularly  termed  the  commencement 
of  the  attack  until  it  ends  in  death,  the  patient  does 
not  move  a  limb,  nor  even  an  eyelid.     The  gradual 
failure  of  respiration  interferes  with  the  natural  puri- 
fication of  the  blood  in  the  lungs,  a  fact  speedily 
attested  by  the  livid,  purplish  appearance  of  the  sur~ 
face.     From  this  lividity  we  are  led  to  conclude  that 
death  takes  place  by  asphyxia.    In  most  cases  of 
sunstroke,  accordingly,  death  comes  on  gradually  by 
arrest  of  respiration,  such  arrest  being  without  doubt 


205 


due  to  direct  paralysis  of  the  respiratory  centres  by 
the  excess  of  heat. 

While  we  know  that  certain  conditions  favor  the 
disorder,  that  a  high  temperature  is  necessary  to  its 
production,  and  can  advise  certain  measures  of  pre- 
caution and  relief  found  useful  by  experience  in  such 
cases,  but  little  can  be  said  of  the  true  nature  of  the 
malady.  It  would  seem  that  the  great  heat  of  the 
body  induces  some  change  in  the  character  of  the 
blood.  Owing  to  this  peculiar  condition  of  the  blood, 
the  regions  of  the  brain  which  normally  control  the 
action  of  the  chest  and  heart  muscles  lose  their  abil- 
ity to  superintend  the  movements  of  breathing  and 
circulation  properly,  and  death  from  asphyxia  fol- 
lows. In  some  cases  it  may  be  that  the  sole  cause  is 
cerebral  meningitis. 

A  person  suffering  from  vthe  phenomena  of  sun- 
stroke should  at  once  be  carried  to  a  cool,  airy  spot 
in  the  shade  of  some  wall,  or  perhaps  to  a  large 
room  with  a  bare  floor,  or,  as  is  sometimes  better,  if 
no  sunlight  interferes,  upon  the  pavement  of  a  back 
yard.  Unnecessary  bystanders  must  be  kept  at  a 
distance,  for,  in  this  as  in  every  other  accident,  the 
patient  needs  all  the  pure  air  to  be  had.  His  cloth- 
ing should  be  at  once  gently  removed,  and  he  should 
be  placed  upon  his  back  with  his  head  raised  a 
couple  of  inches  by  a  folded  garment.  His  entire 
body,  and  particularly  his  head  and  chest,  should 


200 


then  be  profusely  dashed  with  cold  water.  In  pre- 
paration for  this  step,  a  messenger  should  be  de- 
spatched for  a  good  supply  of  ice,  and  several  buckets 
of  ice-water  should  be  made  ready  for  use  as  rapidly 
as  possible.  The  ice-water  must  not  be  sprinkled 
over  the  patient,  but  dashed  against  him  in  large 
bowlfuls.  While  one  person  prepares  the  ice-water, 
and  another  uses  it,  a  third  and  even  a  fourth  may 
employ  themselves  in  rubbing  the  surface  of  the 
patient  briskly,  each  with  a  handful  of  cracked  ice 
enclosed  in  a  towel.  The  purpose  of  these  measures 
is  to  reduce  the  temperature  of  the  body  to  some- 
thing like  a  natural  standard.  When  the  decline  in 
heat  is  noticed,  the  cold  applications  should  cease 
and  the  patient  should  be  carefully  removed  to  a  dry 
spot,  where  the  entire  surface  of  his  body  should  be 
dried  with  towels.  If  any  tendency  toward  a  return 
of  the  high  temperature  should  manifest  itself,  as  is 
sometimes  the  case,  even  after  the  restoration  of 
consciousness,  it  must  be  met  at  once  by  a  renewal 
of  the  cold  applications.  A  second  rise  in  tempera- 
ture need  not  excite  surprise  when  we  reflect  upon 
the  amount  of  superheated  blood  within  the  body 
not  yet  exposed  to  the  influence  of  the  cold  applica- 
tions. 

Another  method  of  treatment  consists  in  wrap- 
ping the  patient  in  a  dry  sheet  and  lifting  him  into 
a  tub  of  water  whose  temperature  lies  between  80° 


20? 

and  85°,  this  temperature  being  then  rapidly  low- 
ered by  means  of  ice.  The  time  of  the  immersion 
should  be  between  fifty  and  sixty  minutes.  In 
many  cases  the  best  resort  will  be  the  neighboring 

pump. 

!  In  cities  a  sunstroke  patient,  when  reached,  may 
be  immediately  stripped  beneath  the  cover  of  the 
ambulance,  and  remedial  measures  applied  during 
his  passage  to  the  hospital.  Many  lives  are  now 
sacrificed  by  the  loss  of  critical  moments  in  the  in- 
terval between  the  finding  of  the  patient  and  his 
arrival  in  the  hospital  ward. 

Artificial  respiration  must  be  resorted  to  as  soon 
as  the  heated  condition  of  the  body  is  overcome,  and 
continued  until  natural  respiration  returns.  The 
dashing  of  cold  water  over  the  chest  and  face  is  a 
useful  means  of  encouraging  a  return  of  the  sus- 
pended function  of  breathing,  but  the  mechanical 
methods  are  best  relied  on  in  the  main  for  this 
purpose. 

Of  drugs  to  be  used  in  this  condition  the  follow- 
ing are  very  warmly  recommended.  Antipyrin 
rapidly  reduces  the  temperature,  but  must  be  used 
with  great  caution  on  account  of  its  depressing  in- 
fluence upon  the  heart.  Quinine  is  very  cooling  in 
cases  where  persons  are  compelled  to  work  for  a  long 
time  in  a  high  temperature,  as,  for  instance,  cooks 
and  firemen  upon  steamers  in  the  tropics.     Chloro- 


ws 


form  will  often  relieve  the  respiratory  and  brain 
difficulties  very  promptly  :  a  few  drops  may  be 
sprinkled  upon  a  handkerchief,  and  held,  for  not 
longer  than  five  seconds,  within  an  inch  or  two  of 
the  patient's  mouth,  the  application  being  repeated 
every  minute.  The  best  stimulant  in  all  such  cases 
is  the  aromatic  spirits  of  ammonia,  ten  or  fifteen 
drops  of  which  may  be  given  in  a  tablespoonful  of 
water  every  few  minutes  for  several  doses. 

During  the  heated  term,  as  it  is  often  called,  all 
use  whatever  of  fermented  or  distilled  drinks  should 
be  abstained  from.  ISTot  only  do  these  favor  in  a 
general  way  a  condition  of  the  system  in  many  re- 
spects similar  to  that  which  precedes  sunstroke,  but 
they  deaden  sensibility  at  the  very  time  when  it 
ought  to  be  most  on  the  alert,  so  that  the  individual 
is  less  able  to  detect  slight  changes  in  his  feelings 
which  might  otherwise  have  served  him  as  useful 
warnings.  The  use  of  such  substances  under  the 
circumstances  seems  as  irrational  as  it  would  be  in 
time  of  great  danger  to  prepare  for  watchfulness  by 
taking  a  dose  of  laudanum. 

Everything  in  any  way  calculated  to  impair  the 
strength  should  be  avoided.  Sleep  is  a  most  wonder- 
ful restorer  of  strength,  and  the  want  of  it  is  often 
caused  by  a  late  evening  meal  of  badly  assorted 
articles.  Defective  ventilation  leads  to  a  subjective 
condition  favorable  to  the  development  of  the  malady 


m 

under  consideration.  Every  evening  in  hot  weather 
a  bath  should  be  taken,  or  at  least  the  body  should  be 
sponged  off  with  water  before  lying  down.  Drink- 
ing large  quantities  of  cold  water  is  to  be  refrained 
from  immediately  before,  during,  and  after  meals. 
For,  the  debility  resulting  from  the  heat  weakens 
the  digestive  powers,  and  water  unnecessarily  par- 
taken in  excess  at  such  times  tends  still  farther  to 
retard  the  digestion  of  the  food  by  weakening  the 
solvent  action  of  the  gastric  secretions.  Loosely- 
fitting,  light-colored  garments  are  to  be  worn,  if 
possible,  particular  attention  in  this  respect  being 
paid  to  the  head,  which  should  be  protected  from 
the  heat  of  the  sun,  while  at  the  same  time  the  cov- 
ering worn  must  not  impede  the  free  circulation  of 
a  current  of  air  about  the  scalp.  A  straw  hat  is  to 
be  preferred,  of  loose  texture  and  with  a  lining  in 
the  crown,  and  its  wearer  will  be  just  so  much  better 
off  than  other  people,  if  the  brim  be  wide  enough  to 
protect  his  neck  and  shoulders. 

The  greatest  care  must  be  taken,  if  work  in  the 
sun  is  found  absolutely  necessary,  that  the  premo- 
nitions already  detailed  do  nat  advance  to  complete 
prostration.  In  such  a  case  discontinuance  of  work 
until  the  disagreeable  symptoms  have  passed  away 
would  seem  to  be  the  only  reasonable  course.  Per- 
sons who  have  once  suffered  from  sunstroke  are 


210 

unable  for  a  long  time  after  to  bear  exposure  to  heat 
without  a  recurrence  of  their  former  symptoms. 

Persons  Unconscious  from  Exposure  to  Cold  re- 
quire a  special  manner  of  treatment.  The  effect  of 
excessive  cold  upon  the  body  as  a  whole,  and  espe- 
cially so  in  intoxicated  persons  who  have  lain  down 
in  the  open  air  to  sleep,  is  at  first  to  produce  un- 
consciousness, which,  if  warmth  is  not  applied,  will 
sooner  or  later  pass  into  actual  death.  When  ex- 
cessive cold  prevails  the  inclination  to  sit  down  or  to 
lie  down  should  be  resisted,  for  this  is  the  first  indi- 
cation of  freezing.  First  a  sleepy  feeling  creeps  over 
one,  and  then  loss  of  consciousness  supervenes. 

In  order  to  restore  a  person  from  this  unconscious 
condition  warmth  may  not  be  rapidly  applied  to  the 
whole  body,  but  it  should  be  thawed  out  by  slow 
degrees.  Farthermore,  the  limbs  must  be  very  care- 
fully handled,  to  avoid  fracturing  any  one  of  them, 
for  cold  renders  them  very  brittle.  The  patient  should 
be  brought  into  an  unheated  room,  undressed,  and 
covered  up  to  the  nostrils  and  mouth  with  snow  or 
powdered  ice,  with  which  he  should  be  constantly 
and  gently  rubbed.  The  snow  should  be  renewed  as 
fast  as  it  melts,  until  the  skin  begins  to  grow  warm 
and  the  limbs  relax.  When  its  vitality  has  returned 
to  the  skin  the  snow  should  be  removed  and  the 
whole  body  rubbed  with  cold  cloths.    Only  now  may 


211 


the  temperature  of  the  room  be  gradually  raised  and 
the  patient  placed  in  a  tepid  bath,  and  afterward  in 
a  warm  one.  From  this  point  the  treatment  usual  in 
the  case  of  lethargic  persons  is  to  be  instituted.  The 
rescued  individual  must  be  restricted  to  a  light  diet 
for  a  day  or  two  after  emerging  from  the  lethargy. 

Foreign  Bodies  in  the  Throat.  It  not  infre- 
quently happens  that  a  piece  of  food  or  some  other 
body  finds  its  way  into  the  back  of  the  mouth  and 
lodges  there,  being  unable  to  pass  farther.  In  such 
case  the  finger,  should  this  be  thought  best,  will  often 
be  able  to  thrust  the  morsel  downward.  A  hairpin, 
straightened  and  then  bent  at  the  extremity,  may 
prove  serviceable  in  dragging  the  impediment  out. 
If  the  body  is  firm  in  character,  we  may  be  success- 
ful in  drawing  it  upward  by  passing  over  it  the  looped 
handle  of  a  scissors  blade,  separated  from  its  fellow 
at  the  rivet.  Fish-bones  may  be  most  readily  re- 
moved from  the  throat  by  swallowing  stale  bread. 
The  danger  of  suffocation  by  foreign  bodies  may  be 
avoided  by  breathing  regularly,  by  eating  and  drink- 
ing slowly,  by  refraining  from  conversation  during 
meals,  and  by  cutting  the  food  into  small  pieces. 

Hemorrhage  is  an  accident  of  very  frequent  oc- 
currence. In  cases  of  severe  bleeding,  when  the 
injury  of  an  artery  is  indicated  by  the  spurting  of 
the  blood  in  a  steady  stream  from  the  wound,  direct 
compression  should  be  exerted  upon  the  bleeding 


n^ 


artery,  either  by  a  finger  inserted  in  the  wound,  oi* 
by  means  of  whatever  object  happens  to  be  at  hand, 
such  as  moss,  lint,  tissue  paper,  or  medicated  cotton, 
until  skilled  assistance  arrives.  A  more  ready 
means  of  compression  is  sometimes  found  in  tying 
the  limb  above  the  wound  with  a  strong  cord,  an 
elastic  band,  or  even  a  pair  of  suspenders.  Above 
all,  a  bleeding  limb  should  be  so  held  as  to  impede 
to  the  utmost  its  circulation,  the  foot,  leg,  or  arm, 
for  instance,  being  held  upwards.  Slighter  hemor- 
rhages may  be  controlled  by  means  of  ice,  cold  water, 
burnt  coffee,  vinegar,  or  the  methods  of  compression 
spoken  of  above.  The  application  of  a  compress, 
however,  is  superfluous,  for  the  coagulation  of  the 
blood  in  cotton,  marine  lint,  oakum,  and  coffee  is 
sufficient  for  the  stoppage  of  hemorrhage.  But  the 
removal  of  these  materials  should  not  be  hastened, 
for  this  may  lead  the  bleeding  to  break  out  afresh. 
The  physician,  moreover,  is  the  one  to  decide  upon 
this  point. 

In  case  of  Nosebleed  it  is  sufficient  in  most  in- 
stances to  fill  the  nostrils  with  cotton  or  soft  paper, 
and  to  leave  it  there  for  some  time.  Wads  of  cotton 
dipped  in  tincture  of  iron  are  only  to  be  applied  in 
slight  and  external  hemorrhages.  Indeed,  one  should 
be  very  careful  in  the  use  of  this  remedy,  or  should 
forego  it  altogether,  for  death  has  been  known  to 
follow  immediately  upon  its  use  in  cases  of  bleeding 


213 


from  a  tooth  or  from  tke  no»e,  by  the  extension  of 
blood-clots  to  the  brain. 

Just  as  there  are  men  whose  bones  break  at  the 
slightest  provocation,  so  there  are  others,  also,  the 
so-called  "  Bleeders,"  in  whom  hemorrhage  of  un- 
usual difficulty  to  control  occurs  with  remarkable 
facility.  The  cause  of  this  condition  seems  to  lie  in 
an  alteration  of  the  walls  of  the  blood-vessels. 

Any  person  who  has  once  suffered  from  a  Hem- 
orrhage from  the  Lungs  or  stomach  should  form 
the  habit  of  carrying  with  him  a  dose  of  gallic  acid 
or  of  ergotin,  such  as  his  physician  may  prescribe, 
or  an  abundant  quantity  of  common  salt,  either  one 
of  these  to  be  taken  in  emergency  dissolved  in  water. 
If  no  water  be  at  hand,  the  remedy  will  be  of  equal 
service  taken  dry.  Farthermore,  such  a  person 
should  habitually  keep  as  quiet  as  possible,  should 
avoid  hot  food  and  hot  drinks,  as  well  as  stimulants 
and  excitations  of  any  kind,  should  prefer  not  eating 
too  much  at  one  time,  but  rather  more  often,  and 
should  live  in  a  well  ventilated  room,  avoiding  too 
warm  or  oppressive  a  temperature.  The  same 
rules  hold  good  in  respect  to  persons  troubled  with 
diseases  of  the  heart. 

In  every  case  of  Injury,  in  cuts,  stabs,  and  gun- 
shot wounds,  in  contusions,  sprains,  dislocations, 
and  fractures,  in  burns,  frostbites,  and  frozen  mem- 
bers, the  first  measure  to  be  adopted  is  the  applica,- 


214 


tion  of  cold  in  the  form  of  ice,  snow,  or  cold  water. 
These  substances  are  best  applied  in  an  animal  blad- 
der or  a  rubber  bag.  When  towels  wet  in  cold  water 
are  used,  they  require  to  be  renewed  every  minute,  for, 
■unless  frequently  changed,  they  really  act  as  poul- 
tices to  the  part,  inviting  what  we  wish  to  prevent. 
Cold  not  only  stanches  any  bleeding  which  may  oc- 
cur, unless  the  hemorrhage  is  altogether  too  severe, 
but  it  also  moderates  the  ensuing  inflanmiation. 
The  injured  part  must  enjoy  perfect  rest  and  must 
be  kept  scrupulously  clean. 

In  Cuts  and  lacerations  of  slight  severity  the 
edges  of  the  wound  should  be  pressed  together  as  soon 
as  the  bleeding  is  stopped,  and  held  firmly  by  strips 
of  adhesive  plaster.  Deeper  wounds  the  surgeon 
will  close  with  sutures.  The  injured  part  must  be 
held  quietly,  as  a  matter  of  course,  in  such  a  position 
that  the  wound  shall  not  begin  to  gape  again. 

A  vessel  divided  with  a  sharp  instrument  pre- 
sents a  more  favorable  outlet  for  the  escape  of 
blood  than  if  torn  across  or  severed  by  a  dull  blade 
or  by  a  serrated  one.  Under  the  latter  circumstances 
the  minute  fringes,  or,  as  it  may  be,  merely  the 
slight  roughness  necessarily  left  about  the  edges  of 
a  vessel  at  the  point  of  division  retard  the  escape  of 
blood  and  furnish  nuclei  upon  which  deposits  of 
blood  may  take  place  in  the  shape  of  clots.  Hence, 
if  we  leave  other  considerations  out  of  sight,  an  in- 


215 


cised  wound  may  be  expected  to  give  rise  to  more 
profuse  hemorrhage  than  a  contused  or  lacerated 
one. 

Lacerated  Wounds  result  from  a  rending  or  tear- 
ing of  the  parts.  Such  wounds  often  occur  in  the 
scalp,  where  a  large  fragment  of  skin  sometimes 
becomes  detached  excepting  for  a  slight  pedicle. 
Never,  under  any  circumstances,  should  such  a  frag- 
ment be  removed,  for  the  scalp  is  so  richly  supplied 
with  blood-vessels  that  injuries  to  it,  which  to  an 
ordinary  observer  appear  of  most  unfavorable  aspect, 
often  heal  notwithstanding  rapidly  and  completely. 

The  same  advice  is  to  be  enforced  in  regard  to 
pieces  torn  from  the  nose  or  from  the  outer  ear,  since, 
even  when  cut  entirely  off  and  stitched  on  again, 
complete  healing  not  infrequently  occurs.  The  same 
is  also  to  be  said  of  wounded  and  torn  fingers,  even 
though  they  adhere  to  the  hand  by  only  a  fragment 
of  skin.  All  wounds  should  be  stitched  as  soon  as 
possible,  for,  if  this  be  neglected,  the  margins  will 
refuse  to  adhere  at  a  later  period,  and  so  the  healing 
process  will  be  delayed  or  wholly  prevented.  The 
elasticity  of  the  skin  pulls  the  margins  of  an  unsewed 
wound  asunder,  especially  in  the  scalp,  where  ery- 
sipelas is  so  likely  to  supervene.  Erysipelas  is  the 
name  given  to  a  form  of  inflammation  which  often 
starts  in  the  edges  of  wounds.  Its  occurrence  indi- 
cates the  beginning  of  decomposition  and  the  forma- 


216 


tion  of  pus,  and  such  a  condition  is  always  to  be 
regarded  gravely. 

The  reduction  of  a  Dislocation  is  to  be  advised  at 
the  earliest  possible  opportunity,  as  its  neglect  allows 
the  muscles  to  stiffen,  thus  holding  the  limb  more 
firmly  in  its  displaced  position.  The  delay  of  a  few 
weeks  renders  a  dislocation  almost  impossible  to 
reduce. 

Fractures.  When  an  injury  occurs  to  the  lower 
limb,  and  it  is  thought  that  a  bone  has  been  broken, 
the  injured  person  should  lie  where  he  has  fallen, 
unless  the  temperature  interdicts,  until  suitable  as- 
sistance arrives.  He  should  then  be  removed  from 
the  spot  in  a  carriage,  or  preferably  in  an  ambulance. 
A  wagon  well  filled  with  hay  will  serve  the  purpose 
equally  well,  especially  if  the  hay  be  so  disposed  as 
to  form  a  hollow  for  the  repose  of  the  injured  limb. 
Before  removal  long  splints  should  be  carefully  ban- 
daged to  both  sides  of  the  limb  without  avoidable 
disturbance  of  the  clothing.  This  is  necessary  in 
order  to  prevent,  as  far  as  possible,  the  grating  of 
one  fragment  of  bone  upon  another  and  the  conse- 
quent destruction  of  the  soft  tissues,  which  is  occa- 
sioned by  the  jarring  of  even  the  easiest  riding 
vehicle,  and  which  will  inevitably  make  the  injury 
far  more  serious. 

Abscess  denotes  the  gathering  of  pus.  If  this 
occur  beneath  the  skin,  and  fluctuation  can  be  felt 


217 


superjficially,  an  incision  should  be  made  by  a  physi- 
cian rather  than  allow  the  abscess  to  open  of  itself  ; 
for,  in  the  former  case,  the  cut  edges  will  unite  rapid- 
ly, while  in  the  latter  the  healing  process  will  be  long 
delayed,  and  a  disfiguring  scar  will  remain,  as  we  so 
often  see  where  a  tooth  has  ulcerated  through  the 
cheek.  Farthermore,  it  sometimes  happens,  espe- 
cially if  the  skin  is  thick,  that  an  abscess  burrows 
beneath  the  skin  instead  of  opening  through  it. 

To  Burns  unsalted  butter,  fresh  oil,  yolk  of  egg, 
or  cold  cream  should  be  applied  at  once.  An  espe- 
cially good  effect  is  gotten  from  linseed  oil  and  lime- 
water  in  equal  parts,  or  from  bicarbonate  of  soda 
with  the  requisite  amount  of  water  to  make  a  paste. 
Over  such  applications  should  be  placed  only  a  very 
light  bandage,  not  a  thick  one  which  will  generate 
warmth.  If  the  burn  is  superficial,  pencilling  with 
collodion  will  be  found  of  service  before  the  forma- 
tion of  blisters,  by  preventing  them  from  forming. 
Blisters  caused  by  burns,  when  they  do  not  evacuate 
spontaneously,  should  be  opened  with  a  clean  needle 
upon  the  second  day,  and  the  tract  should  then  be 
overspread  with  one  of  the  applications  already 
enumerated.  The  skin  should  not  be  hastily  re- 
moved from  the  blister,  for  its  presence  protects  the 
wound.  If  adjacent  parts,  such  as  the  fingers  or  the 
arm  and  chest,  become  involved  in  an  extensive 
burn,  measures  must  be  taken  to  keep  them  apart 


218 


during  the  process  of  healing,  in  order  that  they  may 
not  grow  together.  Pieces  of  linen  soaked  in  emol- 
lient applications  should  therefore  be  placed  between 
the  opposing  wounded  surfaces. 

When  any  one's  clothing  catches  fire,  he  should 
immediately  be  thrown  down  upon  the  ground,  so  as 
to  lessen  the  tendency  of  the  flames  toward  his 
mouth  and  nostrils.  Then,  without  a  moment's 
delay,  he  must  be  rolled  in  the  carpet  or  hearthrug, 
in  order  to  stifle  the  flames,  his  head  alone  being  ex- 
posed that  he  may  be  able  to  breathe.  If  no  carpet 
or  rug  is  at  hand,  take  off  your  coafc  and  use  it  in- 
stead. Keep  the  flame  as  much  as  possible  from  the 
face,  so  as  to  prevent  the  entrance  of  the  hot  air  into 
the  lungs.  This  can  be  done  by  beginning  at  the 
neck  and  shoulders  and  smothering  the  flame  down- 
ward. Should  any  fragment  of  garment  be  found 
adherent  to  the  burned  surface,  it  should  not  be 
separated,  as  the  violence  required  to  remove  it 
necessarily  increases  the  damage  to  the  injured  part. 

Burns  by  lime,  caustic  potash,  and  other  alka- 
lies are  as  a  rule  very  troublesome,  since  not  only 
removal  of  the  cuticle  or  superficial  skin  occurs, 
but  also  destruction  of  the  soft  parts  beneath.  Lime 
is  a  powerful  alkali  and  rapidly  destroys  the  parts 
with  which  it  comes  in  contact.  It  is  useless  to  at- 
tempt to  pick  it  off,  for  the  fingers  remove  no  more 
than  they  come  in  contact  with^  so  an  application 


219 


should  at  once  be  made  of  some  substance  which  will 
unite  with  the  alkali  to  form  a  comparatively  harm- 
less preparation.  To  accomplish  this  we  may  apply 
lemon  juice,  vinegar  diluted  with  water,  or  any  other 
dilute  acid.  These  acids  do  not  undo  what  has  been 
done:  they  only  prevent  farther  mischief.  What  we 
say  in  regard  to  lime  may  also  be  said  of  potash, 
soda,  ammonia,  and  the  other  alkalies. 

Burns  by  sulphuric  acid  (oil  of  vitriol),  nitric 
acid  (aqua  fortis),  and  other  acids.  Just  as  alkalies 
destroy  the  hving  tissues  they  come  in  contact  with, 
so  too  do  acids  of  sufficient  concentration.  In  such 
cases  the  addition  of  water  will  dilute  them  beyond 
their  capacity  to  injure.  The  admixture  of  alkalies, 
such  as  lime-water  or  bicarbonate  of  soda,  neutral- 
izes acids  into  harmless  preparations.  Common  dry 
earth,  gathered  almost  anywhere  and  thrown  in 
handfuls  upon  the  injured  surface,  contains  enough 
alkali  of  one  kind  or  another  to  entitle  it  to  the  con- 
sideration of  being  one  of  the  best,  and  at  the  same 
time  one  of  the  most  easily  obtained  applications  in 
cases  of  burns  by  acids. 

A  Hernia,  or  rupture,  often  menaces  life  by  be- 
coming incarcerated,  that  is  when  a  portion  of  in- 
testine becomes  constricted  by  the  convulsive  grasp 
of  the  muscles  about  one  of  the  abdominal  openings. 
Under  these  circumstances  there  may  develop  a  vio- 
lent peritonitis,  attended  by  severe  pain,  and  followed 


220 


by  gangrene  and  other  fatal  consequences.  The 
symptoms  of  incarceration  are  pain  at  the  seat  of 
rupture  and  in  the  abdomen,  constipation,  belching 
of  wind,  vomiting,  sometimes  vomiting  of  fecal  mat- 
ter. In  order  to  prevent  such  an  incarceration  a 
hernial  patient  should  keep  close  watch  for  its 
earliest  symptoms,  and  especially  for  pain  in  the 
tense,  hard  tumor,  which,  from  being  quite  relaxed 
and  readily  replaced,  has  become  hard,  rigid,  and 
altogether  irreducible.  Upon  the  appearance  of 
symptoms  of  incarceration  a  competent  physician 
should  be  summoned  as  soon  as  possible,  who  will 
endeavor  to  reduce  the  hernia  by  pressure,  but,  if  he 
fail  in  this,  will  not  delay  in  replacing  it  by  opera- 
tion. 

Incarceration  is  the  result  of  a  spasmodic  contrac- 
tion, and  every  hernial  patient  should  keep  always 
at  hand,  by  way  of  precaution  against  the  occur- 
rence of  so  serious  an  accident,  a  dose  of  opium  or 
chloroform  prepared  by  his  physician.  But  if  he  has 
a  well-fitting  truss,  and  knows  how  to  adjust  it,  he 
will  experience  no  farther  inconvenience  from  his 
infirmity,  and  need  not  fear  to  engage  in  his  ordi- 
nary avocations  or  even  to  make  considerable  physi- 
cal exertion.  His  truss,  however,  must  be  obtained 
while  the  hernia  is  still  movable  and  not  too  large  to 
be  returned  into  the  abdominal  cavity.  He  must  also 
keep  his  bowels  regular  and  refrain  from  excesses  in 


221 


eating.  If  the  patient  observes  that  his  hernia  is 
pressing  out  from  beneath  the  pad,  he  must  at  once 
consult  an  expert.  He  must  remember  that  the  com- 
pressing power  of  a  truss  diminishes  with  use,  and 
as  soon  as  he  finds  that  his  truss  no  longer  confines 
the  hernia,  another  must  be  procured.  If  the  means 
of  the  patient  allow,  it  is  well  for  him  to  have  several 
trusses,  in  order  to  be  able  to  make  a  change  in  case 
of  necessity.  The  steady  pressure  of  a  good  truss  is 
capable  of  bringing  about,  especially  in  young  per- 
sons, a  union  of  the  walls  of  the  empty  sac,  and 
thereby  a  radical  cure.  The  continuous  wearing  of 
a  well-fitting  truss,  both  by  day  and  by  night,  is  an 
indispensable  condition  to  the  growing  together, 
where  possible,  of  the  sac-walls,  and  to  the  preven- 
tion of  mcrease  and  of  incarceration  in  the  hernia. 

The  treatment  in  cases  of  Poisoning  requires  the 
stomach  to  be  emptied  as  quickly  as  possible  of  the 
poisonous  substance  by  means  of  vomiting,  purg- 
ing, or  the  stomach-pump.  Tickhng  the  membrane 
of  the  throat  with  the  finger  or  with  the  tip  of  a 
feather  is  in  many  instances  sufficient  to  induce 
vomiting.  Usually  after  the  giving  of  an  emetic 
this  means  is  used  to  hasten  its  action.  Common 
salt  serves  a  useful  emetic  action  when  dissolved  in 
the  smallest  quantity  of  water  which  will  absorb 
it,  and  given  every  minute  until  vomiting  occurs. 
Another  valuable  emetic,  particularly  for  children. 


222 


is  pulverized  ipecacuanha,  which  can  be  had  of  any 
druggist.  Warm  water  is  very  conunonly  used  to 
produce  vomiting,  and  so  too  is  mustard  mixed  in 
warm  water.  After  vomiting  is  begun  there  is 
usually  little  trouble  in  keeping  it  up  by  simply 
giving  a  plenty  of  tepid  water. 

When  the  stomach  cannot  be  emptied  completely 
or  rapidly  enough,  the  poison  ingested  should  be 
rendered  as  harmless  as  possible  by  chemical  decom- 
position with  antidotes,  by  combination  with  some 
other  substance,  so  that  a  less  harmful  product  is 
obtained,  or  by  concealing  and  diluting  it.  With 
this  view  the  albumins  and  the  tannins  are  chiefly 
to  be  employed,  the  former  in  cases  of  poisoning 
from  mineral  acids  and  metals  (other  than  anti- 
mony), because  these  form  an  insoluble  combination 
with  albumin,  the  tannic  preparations  (tannic  acid, 
willow  and  oak  barks,  green  tea,  and  quinine),  when 
the  poison  is  an  alkaloid,  that  is  with  most  forms  of 
vegetable  poisons,  and  with  antimony. 

In  the  treatment  of  poisoned  wounds  we  may 
apply  lime-water,  chlorine  water,  solution  of  potas- 
sium permanganate,  or  actual  caustic,  which  not 
only  neutralize  the  poison,  but  obliterate  the  wound 
as  well.  For  cauterization  any  one  of  the  concen- 
trated mineral  acids  is  to  be  preferred ;  chloride  of 
antimony,  caustic  ammonia,  or  caustic  potash  may 
be  adopted ;  or  the  same  result  may  be  attained  by 


223 


the  application  of  the  cautery  iron,  or,  in  case  of 
necessity,  of  a  heated  poker  or  a  cigar. 

Finally,  the  dangerous  consequences  of  the  poi- 
soning must  be  overcome  by  suitable  measures, 
depression  for  instance  by  stimulants,  and  over- 
stimulation by  depressants. 

Mineral  Poisons  can  be  rendered  harmless,  or  at 
least  modified  in  effect,  by  the  administration  of 
large  quantities  of  warm  milk,  albuminous  fluids, 
demulcents,  or  oleaginous  liquids,  at  the  same  time 
exciting  continual  vomiting.  Fatty  substances,  how- 
ever, must  not  be  given  in  phosphorus  poisoning,  on 
account  of  the  ready  solubility  of  phosphorus  in  fat. 

Arsenical  Poisoning  calls  for  the  immediate 
induction  of  vomiting  and  the  administration  of 
hydrate  of  magnesia,  which  may  be  readily  obtained 
by  adding  calcined  magnesia  to  twenty  times  its 
quantity  of  water.  When  nothing  else  is  at^  hand, 
the  rust-colored  mud  may  be  given,  which  is  to  be 
found  at  the  bottom  of  every  blacksmith's  and  lock- 
smith's extinguishing-barrel.  A  remedy  of  high 
repute  in  such  instances  is  a  mixture  consisting  of 
seven  drachms  of  protosulphate  of  iron,  three  of 
magnesia,  and  half  a  pound  of  water,  a  tablespoon- 
ful  to  be  taken  at  a  time. 

Copper  Poisoning"  and  poisoning  from  verdigris 
is  to  be  treated,  after  vomiting  is  secured,  by  giving 
large  quantities  of  warm  albuminous  water,  mag- 


224 


nesia,  or  milk.  An  excellent  preparation  consists  of 
an  intimate  mixture  of  seven  parts  of  moistened 
iron-filings  with  four  parts  of  flowers  of  sulphur. 

Mercurial  Poisoning  is  to  be  met  by  an  imme- 
diate exhibition  of  demulcents  and  of  substances 
designed  to  disguise  the  mineral  and  to  render  it 
insoluble.  Such  a  remedy  is  fluid  albumin,  the  white 
of  an  egg,  for  instance,  given  every  two  minutes  in 
abundance  of  water.  In  its  absence  the  same  effect 
may  be  reached  by  copious  draughts  of  milk  or  of 
thin  flour  paste.  During  the  period  of  recovery  the 
patient  should  be  fed  only  upon  broths,  milk,  and 
demulcent  drinks.  The  removal  of  the  poison  from 
the  system  may  be  aided  by  administering  iodide  of 
potash,  and  salivation  may  be  diminished  and  the 
fetid  odor  of  the  breath  overcome  by  a  wash  of  chlo- 
rate of  potash,  two  parts  in  one  hundred  of  water. 

Nitrate  of  Silver  Poisoning.  Milk  and  egg- 
albumin  are  excellent  antidotes,  but  the  best  is  a 
strong  solution  of  common  salt. 

Antimonial  Poisoning  requires  as  antidotes  the 
tannic  preparations,  including  the  decoctions  of  tan- 
nin, oak,  and  willow  bark,  quinine,  tincture  of  galls, 
and  black  coffee.  Tannin  itself  is  the  most  effica- 
cious, but  the  preparation  most  readily  obtained  is 
the  familiar  one  of  Chinese  tea.  In  urgent  cases 
magnesia,  soap-suds,  or  the  white  of  an  egg  may 
render  service. 


225 


Acute  Lead  Poisoning  is  treated  by  inducing  vio- 
lent vomiting  and  by  giving  draughts  of  magnesia 
sulphate  in  solution  and  of  salt  water.  In  emergency 
albumin  and  milk  may  be  substituted.  In  cases  of 
lead  colic  warm  wrappings  should  be  applied  to  the 
abdomen,  and  frequently  warm  enemata  should  be 
administered  and  followed  by  opium  and  (5astor-oil. 

Chronic  lead  poisoning  may  result  in  recoveiy 
through  attention  to  a  nourishing  diet,  including 
rich  milk,  to  fresh  air,  to  regular  bathing,  and  to  the 
periodical  action  of  the  bowels.  In  cases  where  lead 
paralysis  supervenes  stated  electrical  treatment  by  a 
physician  is  indispensable,  and  massage  may  be  ser- 
viceably  employed.  Iodide  of  potash  is  the  most 
efficient  agent  for  removing  lead  from  the  system. 

Chronic  lead  poisoning  is  of  frequent  occurrence 
among  workmen  who  come  in  daily  contact  with  the 
metal.  But  it  is  also  innocently  incurred  in  not  a 
few  instances  by  persons  whose  exposure  is  only  in- 
cidental. Among  such  unsuspected  means  of  con- 
veyance may  be  enumerated  the  habitual  drinking 
of  water  which  passes  through  lead  pipes,  and  the 
use  of  cosmetics  containing  lead. 

Free  ventilation  and  scrupulous  cleanliness  con- 
stitute, in  general  terms,  the  most  efficient  safe- 
guards for  those  whose  occupations  involve  prolonged 
exposure  to  lead  and  other  poisons  brought  into  the 
system   through    the   a^gency  of   the   atmosphere. 


m 


Workmen  employed  in  lead  factories  and  those 
otherwise  exposed  to  lead  should  be  compelled  to 
wash  their  hands  and  change  their  outer  clothing 
before  eating.  They  should  also  bathe  regularly 
every  day  upon  leaving  their  work,  and  under  no  cir- 
cumstances should  they  be  suffered  to  eat  or  sleep  in 
or  near  the  workshop.  Inasmuch  as  not  all  pro- 
cesses involved  in  the  manufacturing  of  lead  prepa- 
rations are  attended  with  equal  risk,  the  workers 
should  from  time  to  time  be  transferred  from  one 
department  to  another  or  from  indoor  to  outdoor 
work.  In  order  to  prevent  the  constant  rising  of 
dust  charged  with  lead  particles,  floors  should  be 
frequently  sprinkled,  or  kept  covered  with  moist 
sawdust. 

Phosphorus  Poisoning,  which  most  frequently 
follows  accidents  with  rat-poison  or  with  matches,  is 
indicated  by  the  vomiting  of  matter  with  an  odor 
like  garlic  and  luminous  in  the  dark.  The  best 
emetic  is  sulphate  of  copper,  which  should  be  fol- 
lowed by  copious  draughts  of  some  demulcent,  with 
white  of  egg,  by  the  administration  of  calcined  mag- 
nesia, or  by  that  of  thin  flour  paste.  Fatty  sub- 
stances are  wholly  inadmissible,  for  they  facilitate 
the  solution  of  the  poison. 

Mineral  and  Vegetable  Acids  (sulphuric,  nitric, 
hydrochloric,  oxalic,  acetic,  tartaric,  and  citric  acids, 
and  oil  of  vitriol)  demand  alkalies,  especially  mag- 


227 


nesia,  with  milk,  oil,  syrup,  or  gelatine,  lime-water, 
and  in  circumstances  of  emergency  chalk  or  egg- 
shells in  water,  soap-suds,  ashes,  saleratus,  and  after 
these  copious  draughts  of  water,  milk,  demulcents, 
oil,  or  flour  paste.  Above  all,  the  drinking  of  large 
quantities  of  water,  albuminous  fluids,  and  soap-suds 
is  to  be  advised.  In  cases  of  poisoning  from  oxalic 
acid  or  oxalic  salts  lime-water  is  to  be  given  without 
delay,  or  else  magnesia,  ground  lime,  or  chalk. 

Alkalies  (soap-lye,  potassa,  carbonate  of  soda, 
caustic  ammonia,  and  carburet  of  lime)  may  be  neu- 
tralized by  the  free  drinking  of  acid  beverages,  such 
as  lemonade,  solution  of  tartaric  acid,  vinegar,  and 
also,  for  the  protection  of  the  mucous  membrane  of 
the  stomach,  of  oils  and  demulcent  drinks.  If  the 
external  skin  is  injured  by  carburet  of  lime,  the  lime 
must  not  be  removed  by  water,  but  by  oil. 

Vegetable  Poisons  as  well  as  mineral  must  be 
removed  by  vomiting,  or  by  the  stomach-pump  in 
the  hands  of  a  physician,  and  their  traces  obliterated 
by  means  of  copious  demulcent  drinks.  Afterward, 
in  the  case  of  most  of  these  poisons,  a  decoction  of 
some  tannic  substance  is  to  be  given,  along  with 
strong  black  coffee  or  strong  tea,  while  stimulating 
enemata  of  vinegar  are  administered  in  connection 
with  vinegar  baths.  Upon  the  arrival  of  unconscious- 
ness or  stupor  the  patient  should  be  treated  as  directed 
in  the  section  entitled  "  Trance,"  especially  artificial 


22g 


respiration  by  forcing  air  in  and  out  of  the  lungs  b6- 
ing  resorted  to,  and  continued,  if  necessary,  for  some 
hours.  Another  serviceable  measure  is  the  persist- 
ent application  of  cold,  especially  of  ice  wrappings,  to 
the  head.  For  an  unconscious  condition  of  milder 
degree  we  may  employ  frequent  sprinkling  of  the 
face  with  cold  water  and  continual  exercise  of  the 
patient  to  prevent  his  falling  asleep.  For  this  pur- 
pose the  poisoned  individual  should  be  led  up  and 
down  the  room  between  two  attendants,  if  necessary 
for  some  hours,  no  matter  how  much  against  his 
will  it  may  be.  To  prevent  general  exhaustion  and 
weakness,  wine,  Hoffmann's  anodyne,  and  other 
stimulants  should  be  given. 

The  characteristic  symptoms  of  acute  Opium 
Poisoning  are  deepening  stupor  and  drowsiness, 
contraction  of  the  pupils,  retarded  breathing,  slow 
pulse,  contractile  movements  of  the  skin,  and  finally 
coma  and  general  paralysis.  If  a  physician  is  pre- 
sent, he  will  administer  atropine  or  belladonna;  but 
these  drugs  require  to  be  used  with  skill,  and  a  lay- 
man should  confine  his  efforts  to  the  general  meas- 
ures of  relief  referred  to  in  the  last  paragraph.  He 
will  be  apt  to  find  especial  benefit  in  the  use  of 
strong  black  coffee,  vinegar  baths,  and  artificial  res- 
piration by  pressing  upon  the  abdomen  at  intervals 
of  five  seconds.  Above  all,  he  should  not  omit  to 
induce  vomiting,  and  that  repeatedly. 


229 


Prussic  Acid  Poisoning  is  marked  by  sudden 
paralysis  of  motion  and  respiration,  by  unconscious- 
ness, by  tremblings  and  convulsions,  and  by  small 
pulse  and  cold  extremities.  On  account  of  the  great 
rapidity  of  action  which  characterizes  prussic  acid 
when  taken  into  the  system  the  stomach-pump  is 
the  only  method  available  for  its  removal,  unless 
tickling  the  throat  may  succeed  in  producing  rapid 
emesis.  No  true  antidotes  exist.  In  order  to  restore 
nervous  energy  and  respiration  strong  stimulants 
should  be  given,  ether,  camphor,  and  cold  douches  to 
the  head  and  spine,  as  well  as  artificial  respiration. 

Belladonna  Poisoning  manifests  itself  by  caus- 
ing expansion  of  the  pupils,  disturbance  of  visual 
power,  diminution  of  feeling,  dizziness,  and  mus- 
cular contractions.  The  unconsciousness  which  suc- 
ceeds often  leads  to  delirium,  hilarious  or  furious  in 
character  as  the  case  may  be,  while  the  throat  suffers 
from  dryness,  tickling,  and  an  inability  to  swallow 
which  sometimes  actually  simulates  the  convulsions 
of  hydrophobia.  In  the  hands  of  a  physician  opium 
and  morphine  are  the  proper  antidotes,  but  a  layman 
should  venture  to  employ  nothing  more  dangerous 
than  the  vegetable  preparations  already  enumerated. 
Subsequent  disturbances  of  vision  should  be  treated 
by  the  local  and  internal  use  of  the  calabar  bean. 

Stramonium  and  Hyoscyamus  act  in  a  similar 
manner  to  belladonna,  as  also  does  Tobacco,    The 


\ 


230 


strong  narcotic  poisons,  Hemlock,  Colchicum, 
Aconite,  and  Ergot,  present  also  the  symptoms  of 
inflammation  of  the  stomach  and  intestines,  such  as 
colic,  tenesmus,  and  bloody  diarrhoea.  Digitalis  has 
the  farther  effect  of  slowing  considerably  the  pulse 
and  the  heart-beat.  In  cases  of  poisoning  by  any 
one  of  these  drugs  the  vegetable  and  other  antidotes 
already  referred  to  are  to  be  employed. 

Strychnia  is  the  active  principle  of  the  ''dog- 
button,"  or  nux  vomica,  as  it  is  called  from  the  use 
often  made  of  it.  The  action  of  this  poison  is  so 
rapid  that,  as  in  the  case  of  prussic  acid,"  little  can 
be  done  to  delay  death.  It  has  a  peculiar  power  over 
the  nervous  system,  throwing  the  muscles  of  the 
body,  and  especially  those  of  the  legs  and  head,  into 
violent  convulsive  movement.  The  stomach  must 
be  evacuated  with  the  least  possible  delay,  and,  if 
asphyxia  results  from  the  convulsive  movements  of 
the  chest  muscles,  artificial  breathing  should  at  once 
be  tried,  in  the  hope  of  inviting  back  natural  respira- 
tion. The  best  antidote  is  hydrate  of  chloral.  Others 
are  tannin  and  the  narcotics,  among  them  opium, 
morphine,  and  especially  chloroform,  of  which  latter, 
as  a  rule,  a  large  amount  can  be  borne. 

Toadstools  usually  manifest  their  noxious  effects 
very  slowly,  for  the  poison  symptoms  frequently  ap- 
pear only  after  the  dehcacy  has  been  ten  or  twelve 
hours  in  the  digestive  tract,    Therefore^  besides  e^^ 


231 


ergetic  measures  for  inducing  vomiting,  purgatives 
and  enemata  are  to  be  employed,  such  as  wine  of 
antimony  with  Glauber's  salts,  or,  if  violent  pain  in 
the  abdomen  exists,  still  better  with  castor-oil.  After 
evacuation  of  the  toadstools  vinegar  should  be  given, 
or  mild  ethereal  remedies.  Atropine  in  minute  doses 
acts  as  a  genuine  antidote. 

Acute  Alcoholic  Poisoning  presents  among  other 
symptoms  dilated  pupils,  scarcely  perceptible  pulse, 
and  sometimes  convulsions  and  paralyses.  The 
noxious  principle  may  enter  the  system  through  the 
skin,  the  lungs,  or  the  mucous  membrane  of  the 
stomach.  Bernard  found  that  the  process  of  diges- 
tion ceased  at  once  in  the  stomach  of  a  dog  upon  the 
introduction  of  clear  alcohol.  In  the  same  manner, 
when  alcohol  was  mixed  with  the  food,  digestion  did 
not  commence  with  the  same  promptness  as  when 
food  alone  was  taken.  Very  small  quantities  of 
pure  alcohol  are  enough,  as  a  rule,  to  bring  on 
symptoms  of  acute  poisoning  in  a  very  short  time. 
These  statements  show  that  alcohol  ought  to  be  re- 
garded rather  as  a  poison  under  whatever  circum- 
stances than  as  an  article  of  common  consumption, 
and  that,  no  matter  how  diluted,  it  cannot  fail  of 
having  a  toxic  action  upon  any  animal  tissue  en- 
countered. Like  many  other  poisons  alcohol  is  to  be 
considered  as  one  of  the  most  valuable  drugs  at  the 
service  of  the  physician. 


232 


The  treatment  of  acute  poisoning  by  alcohol  calls 
for  the  removal  of  the  poison  from  the  stomach 
either  by  emetics  or  by  the  stomach-pump,  the  ap- 
plication of  cold  to  the  head,  the  use  of  stimulating 
enemata  with  salt  and  vinegar,  the  administration 
of  strong  black  coffee,  and  the  employment  of  arti- 
ficial respiration. 

The  treatment  of  poisoning  from  noxious  Gases 
is  the  same  as  that  already  directed  in  the  case  of 
*' persons  suffocated."  Acid  gases,  that  is  the  gas- 
eous acids  of  the  mineral  kingdom,  such  as  sul- 
phuric, nitric,  and  hydrochloric  acids,  are  injurious 
to  the  eyes  and  lungs,  and,  when  inhaled  in  con- 
siderable quantities,  produce  fainting  and  suffoca- 
tion. Workmen  in  factories  where  these  acids  are 
used  should  seek  protection,  in  addition  to  that 
given  by  effective  ventilation,  in  such  devices  as 
keeping  before  the  mouth  a  sponge  soaked  in  potash 
solution,  wearing  glasses  whose  rims  are  surrounded 
by  similar  sponges,  and  stopping  the  ears  with  cotton 
steeped  in  oil. 

Chlorine  Gas  causes  extreme  irritation  of  the 
respiratory  tract,  and  must  therefore  be  excluded  by 
such  means  as  those  just  described.  Since  water  has 
a  strong  affinity  for  chlorine,  large  buckets  of  water 
should  stand  in  every  factory  where  the  gas  is  found. 
In  cases  of  poisoning  from  chlorine  the  inhalation  is 
to  be  recommended  of  steam,  chloroform,  etherj  or 
alcohol. 


233 


Carbonic  Acid  Gas  and  carbonic  oxide  gas  are 
attended  by  the  danger  of  speedy  suffocation.  Illu- 
minating gas  in  particular  must  be  handled  with 
the  greatest  care.  Carbonic  acid  is,  moreover,  a  true 
poison,  and  acts  as  such  directly  upon  the  human 
system.  Carbonic  oxide  is  still  more  inimical  to  life, 
and  enfeebles  the  blood  in  particular  by  expelling  the 
oxygen  from  the  blood-corpuscles  and  replacing  it  in 
equal  quantity  itself. 

The  removal  of  the  person  poisoned  out  of  the 
dangerous  atmosphere  must,  as  a  matter  of  common 
sense,  be  the  first  measure  of  our  treatment.  Far- 
ther directions  have  been  given  in  the  section  upon 
"persons  suffocated." 

Animal  Poisons  are  chiefly  carried  into  the  circu- 
lation from  small  wounds  or  abrasions  of  the  skin. 
The  first  need,  therefore,  is  to  protect  the  skin,  espe- 
cially in  injured  localities.  The  next  is  to  prevent 
the  entrance  of  the  poison  into  the  circulation.  With 
this  aim  it  is  best  to  destroy  the  poison  at  once  in 
the  wound  where  it  originated  by  means  of  caustic 
potash,  nitric  acid,  sulphuric  acid,  caustic  ammonia, 
soda,  or  by  actual  fire,  the  hot  iron,  or  a  lighted  cigar. 
An  iron  at  white  heat  gives  less  pain  than  one  ''  black 
hot,"  as  smiths  say ;  for  in  the  latter  instance  the 
heat  is  scarcely  sufficient  to  destroy,  but  only  irri- 
tates, while  in  the  former  the  greater  heat  at  once 
destroys  the  vitality  of  the  part  with  which  it  comes 


334 


in  contact,  and  with  other  tissues  the  nerves  which 
convey  the  sensation  of  pain.  With  a  properly 
heated  iron  not  only  the  surface  is  destroyed,  but 
the  destructive  influence  extends  beyond  and  into 
the  healthy  tissue  far  enough,  if  no  point  is  neg- 
lected, to  ensure  the  purpose  for  which  it  is  used. 

Caustics,  however,  are  not  always  at  hand  when 
such  an  accident  occurs,  so  the  poison  should  at  once 
be  drawn  from  the  wound  by  sucking  it  with  the 
mouth,  and  for  a  considerable  period  of  time.  In  this 
there  is  no  danger  when  the  mouth  is  free  from 
wounds,  especially  if  the  matter  sucked  out  is  expec- 
torated with  the  saliva  and  the  mouth  is  frequently 
rinsed  clean.  After  evacuation  of  the  poison  the 
wound  should  be  carefully  washed,  if  possible,  v/ith 
caustic  ammonia,  salt  water,  vinegar,  soap-suds,  or 
even  with  urine.  When  bleeding  is  profuse  from  the 
wound,  the  poison  is  frequently  washed  completely 
out,  and  therefore  bleeding  is  to  be  prolonged,  when 
necessary,  by  incisions,  by  warm  applications,  and 
by  cupping.  In  order  to  retard  the  entrance  of  the 
poison  into  the  circulation,  the  blood-vessels  supply- 
ing the  region  should  be  obstructed  by  close  com- 
pression or  by  ligation  as  near  as  practicable  to  the 
wound,  and  upon  the  side  of  it  toward  the  heart. 
Then  the  wound  should  be  thoroughly  treated  with 
caustic,  but  not  to  an  immoderate  degree,  or,  still 
better,  with  the  hot  iron.     It  seems  beneficial  for 


235 


some  days  afterward  to  practice  the  drinking  of  hot 
water. 

Hydrophobia  may  occur,  contrary  to  the  popular 
opinion,  at  any  season  of  the  year.  The  avoidance 
of  water  is  a  very  marked  symptom  in  man,  but  no 
mad  dog  avoids  water.  Mad  dogs  cannot  properly 
be  said  to  foam  at  the  mouth,  but  those  whose  cheek 
muscles  are  so  relaxed  that  their  jaws  hang  open 
necessarily  drop  some  saliva  or  mucus.  Quite  as 
untrue  is  the  idea  that  mad  dogs  always  run  straight 
ahead  and  always  carry  their  tails  between  their 
hind  legs.  Such  a  manner  of  conducting  himself 
gives  to  a  dog  the  appearance  not  so  much  of  being 
vicious,  as  of  being  simply  sick.  Mad  dogs  are  apt 
to  be  very  quiet,  sluggish,  and  sullen,  and  to  slink 
away  by  themselves  :  others,  however,  become  rest- 
less and  irritable,  and  bite  and  run  away.  Most 
such  dogs  lose  their  appetite,  but  they  swallow 
very  abnormal  substances,  such  as  earth,  straw, 
and  shreds  of  cloth.  Mad  dogs  all  bark  in  a  peculiar 
manner,  and  this  is  a  characteristic  feature  of  the 
disease.  Their  proclivity  for  biting  exhibits  itself 
rather  against  animals  than  against  men,  and  some- 
times they  confine  themselves  to  snapping  at  inani- 
mate objects  :  yet  they  do  not  always  spare  their 
masters.  They  bite  in  a  noiseless,  insidious  manner, 
without  previous  barking  or  snarling.     Death  fol- 


236 


lows  eight  or  nine  days  later.  The  recognition  of 
hydrophobia^  it  will  accordingly  be  seen,  is  not  with- 
out difficulty,  and  for  this  reason  it  is  to  be  urgently 
recommended  to  every  owner  of  a  dog,  that,  so  soon 
as  he  perceives  in  the  animal  any  departure  from  his 
usual  condition  and  behavior,  immediately  the  object 
of  suspicion  should  be  secluded  from  mankind. 

A  dog  who  has  bitten  a  human  being  is  very  apt 
to  be  slain  at  once  by  the  bystanders.  This  should 
not  be  permitted,  but  the  suspected  animal  should 
be  placed  in  confinement  and  watched  under  proper 
safeguards  for  the  appearance  of  the  disease.  Should 
no  indubitable  symptoms  indicate  the  disease  in  the 
dog,  it  can  be  readily  seen  what  unnecessary  mental 
distress  will  have  been  saved  both  to  the  person 
bitten  and  to  his  friends. 

A  number  of  well  authenticated  instances  are  on 
record  where  the  bite  of  the  common  skunk  or  pole- 
cat has  been  followed,  after  the  usual  period  of  incu- 
bation, by  symptoms  of  rabies.  Out  of  the  forty-one 
cases  recorded  all  except  one,  a  farmer,  who  knew 
of  the  danger  and  took  the  precaution  of  using  prompt/ 
preventive  treatment,  ended  in  death.  Persons  so 
injured  should  promptly  resort  to  the  peculiar  meas- 
ures advised  for  the  treatment  of  poisoned  wounds. 

Snake  Poison,  which,  very  soon  after  the  bite  of 
the  serpent,  causes  violent  incisive  and  radiating 


237 


pains,  as  well  as  a  dark  bluish  swelling  of  the 
wounded  region,  and  later  dizziness,  difficult  breath- 
ing, and  stupefaction,  is  a  colorless,  odorless,  viscid 
fluid,  very  similar  to  olive  oil.  The  poison  of  some 
tropical  snakes  occasions  no  local  symptoms,  because 
death  follows  only  a  few  minutes  after  the  bite. 
Neither  chemical  nor  microscopical  research  has  hith- 
erto furnished  a  satisfactory  explanation  concerning 
these  poisons.  Their  manner  of  operation  too  is 
still  quite  obscure.  Their  effect  is  produced  only  by 
direct  contact  with  the  blood,  which  they  appear  to 
have  the  property  of  decomposing  with  great  rapid- 
ity. The  venom  of  a  snake  has  no  poisonous  action 
when  introduced  into  the  stomach. 

The  poisonous  snakes  are  sluggish  creatures, 
which  seldom  attack  men  unless  provoked.  The 
effect  of  their  sting  is  proportioned  to  the  amount  of 
venom  accumulated.  Whoever  is  bitten  by  one  of 
them  should  at  once  suck  out  the  wound  and  apply 
one  of  the  above  named  cauterants.  Prompt  ampu- 
tation of  the  injured  part  may  be  successful  in  sav- 
ing life.  In  any  case  a  ligature  should  be  applied, 
if  possible,  above  the  wound,  to  be  relaxed,  if  much 
swelling  occurs,  and  again  tightened  when  feasible. 
The  instantaneous  use  of  potassa,  soda,  or,  still  bet- 
ter, of  a  dark  red  solution  of  permanganate  of  pot- 
ash, or  of  the  same  chemical  in  dry  condition  used 


23S 


both  externally  and  internally,  very  often  proves 
beneficial,  as  does  the  practice  of  the  Italian  shep- 
herds of  urinating  upon  the  wound. 

The  slower  action  of  the  heart,  which  is  indicated 
by  a  feeble  pulse  and  by  other  appearances  of  pros- 
tration, calls  for  the  free  use  of  stimulants.  Mar- 
velous stories  are  told  of  the  quantities  of  whiskey 
and  brandy  taken  under  these  circumstances  by  per- 
sons not  addicted  to  their  use.  It  is  often  wise  to 
give  them  freely  at  brief  intervals  until  symptoms 
of  intoxication  appear.  The  great  enfeeblement  of 
the  heart  readily  suggests  laying  the  injured  person 
upon  his  back,  since  this  is  the  position  in  which  the 
powers  of  the  heart  are  least  taxed. 

In  the  cool  season  of  the  year  snake-poison  very 
seldom  has  a  fatal  effect.  An  excellent  precaution 
to  take,  where  children  are  found  in  the  open  air  ex- 
posed to  the  bites  of  snakes,  is  that  of  allowing  fat 
hogs  to  run  about  unhindered,  for  swine  are  insen- 
sible to  the  bites  of  rattlesnakes  and  many  other 
species  of  poisonous  reptiles,  and  consequently  are 
their  most  formidable  opponents.  Yery  exciting 
contests  are  said  to  take  place  between  certain  South 
American  snakes  and  a  species  of  large  lizard,  where 
the  latter  always  comes  off  victorious.  The  lizard  is, 
of  course,  frequently  stung  by  the  snake,  but  resorts 
as  often  to  a  certain  shrub,  by  making  use  of  whose 


23i) 


power  to  neutralize  poisoned  wounds  it  always 
escapes  unhurt. 

Among  the  members  of  the  spider  family  found 
in  tropical  and  sub-tropical  regions  Scorpions  and 
Tarantulas  are  the  most  dangerous.  Caustic  am- 
monia, followed  by  some  oil,  will  be  found  most 
serviceable  in  their  treatment. 

Insect  Bites  are  capable  of  becoming  at  times 
very  dangerous  and  even  fatal,  especially  when  the 
insect  has  rested  upon  decomposing  animal  or  human 
bodies,  and  it  is  a  wise  precaution  therefore  to  treat 
such  a  wound  in  the  same  manner  as  those  made  by 
poisonous  creatures.  Mosquitoes,  wasps,  hornets,  and 
bees  may  produce  violent  inflammation  and  swell- 
ing. First  of  all,  in  such  cases,  the  sting  should  be 
carefully  extracted,  and  then  caustic  ammonia,  cold 
water,  or  vinegar  shoold  be  applied  to  the  wound. 
If  a  swelHng  of  considerable  extent  arises,  a  mix- 
ture may  be  applied  of  equal  parts  of  caustic  am- 
monia, sugar  of  lead,  and  linseed  oil. 

For  the  relief  of  a  Mosquito  bite  the  best  appli- 
cation is  the  aromatic  spirits  of  ammonia.  The  in- 
sect can  be  kept  from  alighting,  however,  by  rub- 
bing the  skin  of  exposed  parts  with  a  piece,  of 
lemon,  or  by  coating  it  with  vinegar  or  with  a  sat- 
urated solution  of  boric  acid.  Bedbugs  may  be 
destroyed  by  applying  kerosene  oil,  or  still  better 


240 


concentrated  acetic  acid,  to  the  crevices  frequented 
by  them. 

Glanders,  when  communicated  to  man  by  an 
affected  horse,  mule,  or  donkey,  must  immediately 
be  treated  by  washing  the  infected  wound  with 
chlorine  water  or  spirits  of  turpentine  and  applying 
a  chemical  caustic  or  the  actual  cautery. 


> 

vri 


CONTAGIOUS  AND  MIASMATIC  DISEASES. 


Medical  science  has  made  many  of  its  most  rapid 
strides  in  recent  times  in  an  effort,  by  no  means  un- 
successful, to  increase  our  knowledge  of  diseases 
which  are  communicable  in  some  manner  from  one 
individual  to  another.  An  incentive  to  this  study  as 
well  as  a  result  of  it  lies  in  the  certainty  that  a  due 
attention  to  necessary  precautions  will  enable  us, 
in  a  large  number  of  instances,  to  escape  these 
diseases. 

Among  the  graver  varieties  of  disease  which  a 
physician  is  called  upon  to  treat  we  include  the  Con- 
tagious, in  which  the  germs  of  disease  are  conveyed 
directly  from  one  individual  to  another,  and  the 
Miasmatic,  in  which  the  disease-germ,  the  so-called 
miasm,  develops  for  the  most  part  beneath  the 
surface  of  the  ground  and  thence  is  conveyed  to  its 
destination  by  the  forces  of  air  or  water.  Among 
contagious  diseases  may  be  enumerated  smallpox, 
scarlet  fever,  diphtheria,  measles,  whooping-cough, 
inflamed  eyes  of  newborn  children,  syphilis,  and 
typhus  fever.  In  another  class  of  diseases  the  prob- 
ability of  personal  contact  is  reduced  to  a  minimum 

24:1  , 


u^ 


as  an  element  of  causation,  while  tlie  miasmatic 
origin  of  the  poison  cannot  be  overlooked.  In  this 
latter  class  the  malarial  diseases  are  universally 
included.  With  regard  to  a  third  group  there  is  still 
dispute  whether  the  disease  can  be  transmitted  di- 
rectly from  person  to  person,  but  all  are  agreed  that 
the  infected  individual  can  infect  a  locality.  Here 
we  find  included  typhoid  fever,  cholera,  and  the 
plague,  and  to  this  group  the  name  of  Miasmatic- 
contagious  is  commonly  applied. 

The  germs  of  the  contagious  and  miasmatic  dis- 
eases are  known  to  belong  among  the  lower  forms 
of  life,  whether  more  properly  in  the  animal  or  in 
the  mineral  kingdom  has  not  been  determined.  To 
them  the  collective  name  of  bacteria  is  given  by 
scientists,  a  name,  however,  which  includes  as  well 
many  species  which  give  no  evidence  of  being  harm- 
ful, and  some  which  are  certainly  beneficial  to  man- 
kind. Bacteria  occur  in  earth,  air,  and  water  in 
incredible  numbers.  It  is  a  mistake,  however,  to 
suppose,  as  alarmists  imply,  that  disease-germs  lurk 
in  every  crevice,  are  floated  upon  every  wave,  and 
are  blown  to  us  by  every  breeze.  ^Nevertheless,  they 
are  sufficiently  abundant  and  sufficiently  virulent, 
under  many  conditions,  to  necessitate  careful  pre- 
cautions whenever  danger  of  infection  is  thought  to 
exist. 

The  bacteria  of  disease,  while  of  infrequent  occur- 


243 


rence  in  the  atmosphere,  may  be  detected  quite  gen- 
erally in  soil  and  water  in  the  vicinity  of  human 
settlements,  and  especially  where  they  have  been 
deposited  from  the  dejections  of  the  sick.  They  are 
capable  in  some  instances  of  transportation  for  long 
distances  by  currents  of  water  either  above  or  be- 
neath the  surface  of  the  ground.  They  may  remain 
an  indefinite  length  of  time  within  the  soil  without 
losing  their  activity  in  the  production  of  disease,  a 
fact  often  attested  upon  the  disinterment  of  bodies 
long  buried.  They  have  been  known  to  linger  many 
years  in  garments,  which  have  been  used  in  the  sick 
chamber  where  contagious  disease  existed,  and  which 
have  then  been  packed  away  without  proper  disin- 
fection. Particularly  is  the  latter  the  case  where 
scarlet  fever  has  prevailed. 

Professor  Welch,  of  Baltimore,  says,  in  an  ad- 
dress upon  this  subject,  '^Manifold  are  the  ways  in 
which  we  may  be  brought  into  contact  with  infec- 
tious bacteria  in  the  ground,  either  directly  or  indi- 
rectly by  means  of  vegetables  to  which  particles  of 
earth  are  attached,  by  the  intervention  of  domestic 
animals,  by  the  medium  of  flies  or  other  insects,  and 
in  a  variety  of  other  ways  more  or  less  apparent. 

''An  important,  doubtless  for  some  diseases  the 
most  important,  medium  of  transportation  of  bac- 
teria from  an  infected  soil  is  the  water  which  we 
drink  or  use  for  domestic  purposes.     It  is  not  the 


^44 


subsoil  water  which  is  dangerous,  for  infectious,  like 
other  bacteria,  cannot  generally  reach  this  in  a  living 
state,  but  the  danger  is  from  the  surface  water  and 
from  that  which  trickles  through  the  upper  layers  of 
the  ground,  as  well  as  from  that  which  escapes  from 
defective  drains,  gutters,  cesspools,  privy  vaults,  and 
wrongly  constructed  sewers,  or  improper  disposal  of 
sewage. 

"Pathogenic  bacteria  may  preserve  their  vitality 
longer  in  ice  than  in  unsterilized  drinking  water. 
Thus,  Prudden  found  typhoid  bacilli  ahve  in  ice 
after  103  days. 

"Among  the  various  agencies  by  which  infectious 
organisms  may  gain  access  to  the  food  may  be  men- 
tioned the  deposition  of  dust  conveyed  by  the  air, 
earth  adhering  to  vegetables,  water  used  in  mixing 
with  or  in  the  preparation  of  food,  in  cleansing 
dishes,  cloths,  etc.,  and  contact  in  manifold  other 
ways  with  infected  substances. 

"Fortunately  a  very  large  part  of  our  food  is 
sterilized  in  the  process  of  cooking  shortly  before  it 
is  partaken,  so  that  the  danger  of  infection  from  this 
source  is  greatly  diminished,  and  comes  into  con- 
sideration only  for  uncooked  or  partly  cooked  food, 
and  for  food  which,  although  it  may  have  been 
thoroughly  sterilized  by  heat,  is  allowed  to  stand  a 
considerable  time  before  it  is  used.  Milk,  in  conse- 
quence of  its  extensive  employment  in  an  unsteril- 


245 


ized  state,  and  of  the  excellent  nutritiVe  conditions 
which  it  presents  to  many  pathogenic  bacteria, 
should  be  emphasized  as  especially  liable  to  convey 
certain  kinds  of  infection — a  fact  supported  not  less 
by  bacteriological  than  by  clinical  observations. 
Upon  solid  articles  of  food  bacteria  may  multiply  in 
separate  colonies,  so  that  it  may  readily  happen  that 
only  one  or  two  of  those  who  partake  of  the  food  eat 
the  infected  part,  whereas  with  infected  liquids,  such 
as  milk,  the  infection  is  more  likely  to  be  trans- 
mitted to  a  larger  number  of  those  who  are  exposed. 

'^  In  another  important  particular  the  food  differs 
from  the  other  sources  of  infection  which  we  have 
considered.  Not  only  the  growth  of  infectious  bac- 
teria, but  also  that  of  bacteria  incapable  of  multipli- 
cation within  the  body,  may  give  rise  in  milk  and 
other  kinds  of  food  to  various  ptomaines,  products 
of  fermentation,  and  other  injurious  substances, 
which,  when  ingested,  are  likely  to  cause  more  or 
less  severe  intoxication,  or  to  render  the  alimentary 
tract  more  susceptible  to  the  invasion  and  multipli- 
cation of  infectious  organisms." 

The  agencies  by  which  bacteria  may  be  sterilized 
or  destroyed  are  heat,  cold,  and  chemical  action,  the 
latter  consisting  in  contact  with  certain  "  anti- 
septics/' among  which  we  may  mention  corrosive 
sublimate  and  carbolic  acid  as  being  especially 
effective.     In  order  that  the  bacteria  of  infectious 


246 


diseases  may  exert  their  activity  a  suitable  "  soil " 
must  be  furnished  in  the  persons  of  those  subjected 
to  their  attacks.  Such  activity  is  always  favored  by 
ill  health,  starvation,  bad  air,  especially  when  con- 
taminated with  sewer-gas,  by  unhealthy  occupations, 
the  use  of  alcohol,  and  by  whatever  else  tends  to 
deplete  the  vitality  of  the  individual. 

When  a  number  of  persons  are  taken  sick  in  the 
same  neighborhood  at  one  time  with  similar  symp- 
toms, the  outbreak  is  termed  an  "  epidemic "  or 
"pestilence."  If  the  same  disease  returns  often  to 
a  given  locality,  or  if  it  remains  there  continuously, 
it  is  said  to  be  "endemic"  or  domesticated.  When 
cases  of  sickness  multiply  and  a  disease  becomes 
epidemic,  the  utmost  care  should  be  exercised  by 
everyone  to  avoid  exposure  in  any  way  to  the  germs 
of  contagion. 

A  principal  source  of  many  dangerous  diseases, 
and  not  alone  of  those  which  are  epidemic  in  ten- 
dency, but  especially  of  cholera,  typhoid  fever,  yel- 
low fevej,  and  the  plague,  lies  in  the  decomposing 
excrements  of  human  beings,  and  more  particularly 
of  those  who  are  sick.  The  greater  the  degree  of 
cleanliness  observed  in  regard  to  the  removal  and 
disinfection  of  such  materials,  the  more  certainly  do 
we  by  these  means  secure  our  own  health. 

Porous  objects  and  those  which  are  dark- colored 
or  rough  seem  to  absorb  and  to  retain  the  germs  of 


247 


miasma  and  of  contagion  more  readily,  and  probably 
also  in  larger  quantity,  than  those  which  are  dense, 
smooth,  and  light  in  color.  For  this  reason  dark 
woolen  uniforms  should  not  be  worn  by  professional 
nurses;  and  physicians,  upon  leaving  such  a  patient, 
should  take  the  precaution  of  at  once  changing  their 
clothing  and  thoroughly  disinfecting  that  they  have 
worn.  At  the  same  time  those  who  wear  beards 
should  thoroughly  cleanse  them.  It  is  far  simpler 
and  more  cleanly,  however,  if  no  beard  be  worn. 

The  most  frequently  encountered  of  the  endemic 
diseases  are  the  Intermittent  and  Malarial  Fevers 
which  originate  in  the  neighborhood  of  swamps. 
Any  one  who  is  forced  to  hve  in  a  malarial  region 
should  exercise  great  care  in  avoiding  the  damp, 
misty  air  of  evening,  especially  if  he  is  not  accli- 
mated, and  equally  the  heavy  dew  of  the  morning, 
or,  if  he  finds  it  impossible  wholly  to  avoid  these,  he 
should  at  least  keep  himself  in  constant  motion  at 
these  seasons  of  the  day.  He  should  wear  next  his 
skin  a  long  woolen  undershirt,  should  indulge  fre- 
quently in  warm  bathing,  should  carefully  ^void 
getting  wet  and  catching  cold,  should  not  lie  down 
on  the  ground  nor  sleep  in  the  open  air,  should 
occupy  a  dwelling  and  especially  a  sleeping-room  as 
high  above  the  ground  as  may  be,  should  avoid  the 
vicinity  of  newly  broken  ground,  should  combat  the 
malarial  drafts  of  air  near  the  floor  by  means  of  a 


248 


fire,  should  live  frugally  and  temperately,  avoiding 
excesses  of  every  sort,  and  should  refrain  from  eat- 
ing indigestible  fruits,  fish,  or  vegetables,  and  par- 
ticularly in  the  form  of  salads.  He  should  not  go 
about  with  an  empty  stomach,  should  drink  no  im- 
pure water,  but  should  purify  his  water  before  drink- 
ing by  boiling  or  filtering. 

Intermittent  and  malarial  fevers  owe  their  origin 
as  a  rule  to  air  contaminated  with  carburetted  hy- 
drogen and  with  other  gases  which  spring  from  de- 
composing vegetable  and  animal  substances  or  from 
freshly  broken  ground.  The  draining  of  swampy 
regions  is  regularly  followed  by  the  disappearace  of 
malaria.  In  many  cases  malaria  is  due  rather  to 
bad  sewerage  than  to  natural  surroundings,  and  thus 
is  traceable  to  human  neglect  rather  than  to  faults 
of  nature.  Intermittent  fever  is  distinguished  from 
malarial  by  the  regularly  recurring  intervals  which 
separate  the  paroxysms  of  fever. 

The  diet  in  malaria  should  be  very  light,  exclud- 
ing fruit  and  raw  vegetables.  Lemons  and  lemon- 
ade, however,  may  be  freely  indulged  in  as  possess- 
ing germicide  properties.  Wherever  possible,  red 
pepper  should  be  added  to  the  food,  its  strength 
being  ameliorated  by  the  use  of  boiled  milk,  sugar, 
and  other  bland  articles.  The  drugs  prescribed  by  the 
physician  should  be  continued  some  time  after  the 
disappearance  of  symptoms.     Malaria  is  liable  to 


^40 


reappearance  upon  leaving  a  malarial  for  a  non- 
malarial  district,  and  even  upon  undertaking  an 
ocean  voyage;  therefore  anti-malarial  remedies 
should  be  renewed  at  every  such  time. 


TYPHOID    FEVER. 

Typhoid   fever    is  a    very  treacherous    disease, 
whose  termination  can  never  be  foreseen  with  cer- 
tainty.   It  may  be  prevented  by  prompt  disposal  of 
all  decomposing  substances,  such  as  diseased  meat, 
tainted  sausage,  spoiled  fish,  poisoned  cheese,  contam- 
inated milk  or  water,  by  immediate  removal  and  disin- 
fection of  the  excrements,  by  thorough  cleanliness  in 
every  respect,  by  adherence  to  a  diet  of  nourishing, 
easily  digestible  food,  by  drinking  no  water  but  that 
which  has  been  boiled,  by  observing  regular  habits 
of  life,  by  maintaining  good  spirits,  by  refusing  to 
live  in  any  but  a  healthy  house.     Sewer  gas,  escap- 
ing in  a  house,  forms  an  especial  menace  to  health. 
Enough  cannot  be  said  by  way  of  warning  against 
excesses,  during  convalescence  from,  this  disease,  in 
eating  articles  difficult  to  digest,  or  in  partaking  of 
foods  and  drinks  which  have  a  tendency  to  overheat, 
to  bloat,  or  to  irritate  the  stomach.     Such  indulgence 
not  rarely  proves  fatal.   Farthermore  at  this  time  all 


250 


edibles  should  be  avoided  which  contain  stones, 
kernels,  skins,  and  husks,  for  the  passage  of  these 
substances  through  the  intestine  is  liable  to  tear  the 
tender  membrane  from  freshly  healed  typhoid  ulcers, 
and  even,  by  opening  a  passage  into  the  abdominal 
cavity,  to  cause  fatal  results. 

*'Two  methods  of  prevention,  having  the  same 
general  object  in  view,  are  to  be  recommended. 
The  first  involves  the  thorough  disinfection  of  all 
discharges  from  the  bowels  of  typhoid  fever  pa- 
tients. This  is  best  done  by  the  use  of  a  solution 
of  chloride  of  lime,  eight  ounces  to  the  gallon  of 
water,  using  a  quart  of  this  solution  for  each 
discharge,  and  allowing  it  to  stand  in  the  vessel  at 
least  an  hour  before  emptying.  A  solution  of  corro- 
sive sublimate,  two  drachms  to  the  gallon  of  water, 
will  answer  the  same  purpose,  but  requires  to  remain 
longer  in  contact  with  the  material  to  be  disinfected. 
Bed  and  body  linen  soiled  by  such  patients  should  be 
disinfected  by  the  use  of  the  same  solution  or  by 
boiling. 

"The  second  method  relates  to  avoiding  the  use 
of  suspicious  water,  and  especially  well  water,  and 
where  this  cannot  be  done,  to  boiling  such  water  be- 
fore it  is  used  for  drinking  purposes.  In  the  absence 
of  a  pure  and  well-guarded  public  water  supply, 
properly  stored  cistern  water  is  probably  open  to 
least  objectiojx," 


251 


YELLOW   FEVER. 

Yellow  fever  occurs  only  in  tropical  and  sub- 
tropical countries  along  the  coast  and  in  the  low 
lands  about  rivers,  but  never  in  mountainous  dis- 
tricts. The  disease  attacks  chiefly  the  unacclimated, 
and  especially  those  who  live  in  a  manner  unsuited 
to  the  cliniate,  overloading  their  stomachs  with  meat 
and  with  indigestible  fruits,  indulging  in  intoxicating 
liquors,  exposing  themselves  to  the  night  air  and 
dew,  and  paying  insufficient  attention  to  cleanliness 
of  person,  clothing,  and  dwelling.  Yellow  fever  is 
attended  with  very  rapid  decomposition  of  the  blood, 
with  vomiting  of  blood,  and  with  jaundice.  Migra- 
tion to  a  mountainous  region  is  the  surest  means  of 
protection  against  this  fever.  Those  who  are  un- 
able to  leave  the  infected  locality  should  at  least  spend 
their  nights  in  as  high,  cool,  and  airy  «,  building  as 
possible,  outside  city  limits,  and  preferably  upon  a 
sandy  soil.  A  city  frequently  infested  with  yellow 
fever  is  Rio  de  Janeiro,  and  chiefly  for  the  reason 
that  an  overhanging  mountain  (which,  however, 
must  sooner  or  tater  be  removed)  obstructs  the  ac- 
cess of  the  trade  winds,  and  so  interferes  with  the 
ventilation  of  the  city. 

"  For  persons  detained  in  an  infected  city  by  duty 
or  necessity  the  best  advice  that  can  be  given  is  to 
maintain  a  cheerful  franae  of  mind ;  avoid  excesses 


252 


of  all  kinds  ;  keep  away  from  centres  of  infection 
(as  shown  by  the  occurrence  of  numerous  cases); 
sleep  as  far  from  the  ground  as  possible  ;  keep  the 
bowels  open.  In  malarial  localities  it  is  well  to  take 
prophylactic  doses  of  quinine,  as  an  attack  of  mala- 
rial fever,  like  anything  else  that  disturbs  the  bal- 
ance of  health,  is  very  likely  to  eventuate  in  an  at- 
tack of  the  prevailing  disease. 

**Many  cases  are  of  so  mild  a  type  that  recovery 
may  take  place  under  the  most  adverse  circum- 
stances and  even  in  spite  of  heroic  treatment.  On 
the  other  hand,  certain  cases  are  of  so  malignant  a 
character  that  no  amount  of  skill  and  care  can  avert 
a  fatal  termination.  But  between  these  extremes 
is  a  considerable  number  of  cases  in  which  the  bal- 
ance of  life  and  death  is  in  the  hands  of  the  attend- 
ant. An  ill-timed  cathartic,  a  discouraging  word, 
permission  to  sit  up,  or  to  partake  of  solid  food,  ex- 
posure to  drafts,  in  short,  many  things  which  to  the 
inexperienced  may  appear  trivial,  when  thrown  into 
the  balance,  in  this  disease,  may  turn  the  scale  to  the 
fatal  side.  On  the  contrary,  encouraging  words  to 
the  patient,  vigilant  supervision  of  all  that  occurs 
in  the  sick-room,  the  timely  administration  of  stimu- 
lants, and  in  short,  close  attention  to  all  the  details 
of  what  is  known  as  'nursing'  will  tide  many  a 
patient  over  the  critical  periods  of  the  disease,  and 
save  his  life," 


DISEASES  OF  THE  NERVOUS  SYSTEM. 


HYSTERICAL  ATTACKS. 

Hysterical  attacks  are  occasioned  in  some  in- 
stances by  mental  impressions,  in  others  by  disturb- 
ances of  one  or  another  organ,  and  especially  of  the 
organs  of  generation.  The  origin  of  this  malady 
seems  to  lie  in  a  certain  physical,  or,  more  correctly 
perhaps,  in  a  certain  psychical  makeup  of  the  indi- 
vidual. The  fact  that  women  of  strong  wills,  do- 
mestic capacity,  and  active  incUnation  are  almost 
free  from  hysteria  may  be  taken  as  evidence  that  it 
is  possible  to  prevent  its  occurrence  in  most  in- 
stances by  a  judicious  bodily  and  mental  training. 
The  physical  training  should  be  so  directed  as  to 
overcome  any  tendency  to  effeminateness.  The 
moral  sense  and  the  inchnation  to  useful  activity 
must  be  aroused  and  developed.  Force  of  will  must 
be  cultivated,  in  order  that  the  woman  may  gain 
power  to  maintain  a  mind  free  from  all  sentimentahty 
and  constantly  under  the  control  of  reason.  When 
a  woman  comes  into  circumstances  which  force  her 
to  prove  her  skill  in  useful  occupations,  or  when  a 
happy  marriage,  richly  blessed  with  children,  brings 

253 


254 


to  her  the  necessity  of  planning  daily  for  the  educa- 
tion, the  food,  the  clothing,  and  all  the  other  details, 
which  make  up  the  sum  of  comfort  for  her  honseliold, 
all  nervous  manifestations  are  likely  to  disappear. 

The  treatment  of  hysteria  should  begin  with  a 
careful  examination,  especially  in  respect  to  the  re- 
productive system.  It  should  then  be  seen  to  that 
the  patient  has  sufficient  regular  occupation  of  a 
practical  nature,  in  household  industries,  for  instance, 
or  in  the  care  of  garden  and  flower-beds  and  other 
rural  occupations,  or  in  gymnastic  exercises,  swim- 
ming, skating,  and  the  like.  Beside  this  some  taste- 
ful employment  of  great  interest  to  the  patient  is  to 
be  desired,  such  as  singing,  piano-playing,  or  paint- 
ing. In  this  respect  sketching  in  the  open  air  is  to 
be  preferred.  It  is^  very  desirable  that  the  diet 
should  be  such  as  to  furnish  abundant  nutriment  to 
the  nervous  system,  without  overtaxing  the  digestive 
organs. 

EPILEPSY   AND    ST.    VITUS'S    DANCE. 

Among  essentially  spasmodic  diseases  those  of 
most  frequent  occurrence  are  epilepsy  and  St.  Vi- 
tus's  dance.  The  treatment  should  aim  to  secure 
adequate  rest,  physical,  mental,  and  sexual,  to  sup- 
ply nutritious,  easily  digestible,  but  none  the  less  en- 
riching food,  and  to  provide  for  the  breathing  of  pure 


255 


air.  The  judicious  employment  of  gymnastic  exer- 
cises will  be  found  an  efficient  aid  in  restoring  the 
control  of  the  will  over  the  muscular  system.  Suc- 
cessful treatment  should  be  followed  by  extensive 
rural  excursions. 

The  diet  of  the  epileptic  must  be  of  the  simplest 
kind.  Vegetable  food  is  preferable.  Many  children 
never  would  become  epileptics  but  for  injudicious  in- 
dulgence in  animal  food.  The  greatest  care  must 
be  paid,  not  only  to  diet,  but  to  the  general  habits  of 
the  patient.  Over-exercise,  especially  after  eating, 
long  continuance  in  a  hot  place  or  at  a  high  altitude, 
excitement,  over-study,  and  all  other  agencies  which 
favor  cerebral  congestion  are  to  be  avoided. 

Often  an  epileptic  seizure  is  ushered  in  by  the  ut- 
terance of  a  peculiar,  sharp  cry,  as  the  individual 
falls.  Immediately  froth  exudes  from  the  mouth, 
sometimes  froth  tinged  with  blood.  All  that  can  be 
done  for  the  relief  of  the  patient  is  to  keep  him  from 
injuring  himself  or  others  during  the  violent  con- 
vulsive movements  by  removing  him  to  some  clear 
space,  where  there  is  nothing  to  strike  against.  !N"o 
attempt  should  be  made  to  hold  even  the  limbs,  but 
everything  should  be  loosened  about  the  throat  and 
chest.  A  cork  or  some  other  hard  substance  should 
be  placed  between  the  teeth  to  prevent  biting  the  lips 
and  tongue.  In  the  meanwhile  no  crowd  must  be 
allowed  to  gather  about  the  spot.     This  is  a  very  im- 


256 


portant  measure  of  assistance  in  convulsions,  as  it  is 
in  every  other  emergency. 

Persons  subject  to  epileptic  convulsions  should 
never  be  permitted  to  go  from  home  without  a  strip, 
containing  the  name  of  the  individual,  residence  and 
the  name  of  his  disease,  being  attached  inside  the 
coat,  where  it  will  at  once  be  seen  upon  opening  the 
clothing.  It  will  frequently  afford  desired  relief,  if 
those  who  are  afflicted  with  spasmodic  or  painful 
diseases  would  form  the  habit  of  carrying  a  bottle 
of  chloroform,  to  be  applied  to  the  nostrils  at  the  first 
intimation  of  a  spasm.  None  but  a  physician,  how- 
ever, should  be  permitted  to  hold  chloroform  to  the 
nose  of  another  person. 

Convulsions  in  children  may  sometimes  be  re- 
lieved, in  advance  of  the  doctor's  arrival,  by  the 
administration  of  a  mild  purgative  in  the  form  of  an 
enema  of  warm  soap-suds  and  castor-oil,  or  of  a  tea- 
spoonful  of  glycerine  introduced  into  the  lower  bowel. 
In  many  cases  benefit  is  experienced  from  the  use  of 
a  hot  bath  or  of  a  mustard  bath,  cold  applications 
being  made  at  the  same  time  to  the  head. 

INSOMNIA. 

Insomnia  always  proceeds  from  irritation  of  the 
sensory  nerves,  whether  such  irritation  is  psychical 
in  character,  such  as  severe  emotional  disturbances, 


?.-:i 


strong  mental  exertion,  and  severe  pain  ;  or  whether 
physical  irritation  arises  from  disordered  blood,  from 
fever,  from  intoxication,  from  consmiiption  at  a  late 
hour  of  tea,  coffee,  and  wine,  from  tobacco-smok- 
ing, from  the  abuse  of  narcotics,  from  itching  dis- 
eases of  the  skin,  from  coughing,  from  heart  palpi- 
tation, or  from  shortness  of  breath.  The  treatment 
of  insomnia,  whether  it  occurs  independently,  or  is 
dependent  upon  some  other  condition,  must  be  di- 
rected mainly  to  avoidance  of  the  causes  enum- 
erated ;  consequently  careful  attention  must  be  paid 
to  securing  mental  and  bodily  quiet,  to  employing 
the  mind,  and  to  the  judicious  regulation  of  all  phys- 
ical and  mental  activities.  For  instance,  no  indul- 
gence of  passion  should  be  allowed  just  before  retir- 
ing, and  at  this  hour  even  chess  and  card-playing 
should  be  eschewed.  The  head  must  never  be  cov- 
ered by  the  bed-clothing.  Wall-papers  ought  not  to 
contain  arsenic.  The  sleeping-room  should  be  cool 
and  airy,  the  bed  warm,  and  the  light  should  be  ex- 
tinguished on  retiring.  Frequently,  before  going  to 
bed,  it  is  serviceable  to  employ  derivatives,  such  as 
foot-baths,  mustard  poultices  to  the  calves,  and  ene- 
mata.  For  the  old  and  feeble  a  glass  of  strong  beer 
or  of  old  wine  drank  just  before  retiring  is  sometimes 
of  great  service.  Younger  persons,  who  are  inclilied 
to  palpitation  of  the  heart,  may  experience  a  like 
benefit  from  bathing  the  upper  portion  of  the  body 


258 


and  drinking  a  glass  of  cool  water  which  contains 
some  effervescent  powder.  Not  only  is  even  a  small 
quantity  of  beer  a  good  soporific,  especially  for  those 
unaccustomed  to  it,  but  an  equally  good  effect  can 
often  be  produced  by  laying  the  head  upon  a  pillow 
filled  with  hops.  Counting  is  an  artificial  method 
sometimes  successful. in  inducing  sleep,  and  so  with 
some  is  reading  in  bed.  No  resort  should  ever  be 
taken  to  drugs  for  this  purpose,  unless  by  order  of  a 
physician. 

Insomnia  is  not  infrequently  associated  with 
dyspepsia  and  other  debilitated  conditions.  Persons 
so  troubled  are  to  be  instructed  to  eat  something  before 
going  to  bed,  having  put  aside  work  entirely  at  least 
an  hour  before.  If  not  hungry,  they  should  simply 
be  told  to  eat,  and  if  hungry,  they  should  eat  what- 
ever they  want.  In  a  short  time  the  night  appetite 
will  grow.  Before  eating  a  bath  should  be  taken. 
Cool  baths  are  preferable,  given  with  a  sponge  or 
stiff  brush,  the  body  being  well  dried  with  a  coarse 
towel  afterward.  After  the  bathing  and  rubbing, 
or  after  eating,  a  moderate  amount  of  out-door  exer- 
cise should  be  taken,  or  in  winter,  a  few  minutes  with 
Indian  clubs  or  dumb-bells.  Farther  than  this,  the 
individual  should  go  to  bed  at  the  same  hour  every 
night,  and  arise  at  the  same  hour  every  morning. 
Good  digestion  and  regularity  of  the  bowels  are  of 
no  small  importance  in  point  of  undisturbed  repose. 


DISEASES  OF  ALTERED  NUTRITION. 


ANJEMIA    AND    CHLOROSIS. 

A  substantial,  light  diet,  and  a  healthy  way  of 
living  are  important  factors  in  dealing  with  anaemia 
and  chlorosis,   for  in  these  diseases,   as  in  all  the 
others  of  their  class,  the  origin  of  the  difficulty  lies 
in  a  disproportion  between  the  consumption  and  re- 
newal of  the  blood — a  fluid  indispensable  to  life,  since 
it  nourishes  all  parts  of  the  body  and  forms  the 
source  of  bodily  warmth.     Anaemia  is  followed  by  a 
variety  of  ills,  such  as  faintness,  failure  of  strength, 
chills,  dryness  of  the  skin,  palpitation,  fragility  of 
the  blood-vessels,  causing  nasal  and  other   hemor- 
rhages, migraine,  pains  of  different  sorts  in  the  back 
and  in  the  nervous  centres,  even  St.  Vitus's  dance, 
epilepsy,  hysteria,  melancholia,  sensory  disturbances, 
and  fainting.     Among  the  exciting  causes  may  be 
enumerated  deficient  supply  of  food,  want  of  light 
and  air,  excess  or  deficiency  of  bodily  exercise,  hem- 
orrhages, pathological  growths  and  discharges,  dys- 
pepsia.    All  of  these  conditions  furnish  individual 
indications  in  regard  to  treatment. 

259 


260 


Anaemic  persons  are  to  be  advised  to  abstain  from 
cold  baths  and  douches,  as  being  too  severe  irritants  ; 
and  for  a  similar  reason  strong  coffee  and  tea  are  to 
be  interdicted.  On  the  other  hand  warm  and  luke- 
warm baths  may  be  recommended.  Soup  is  better 
eaten  at  the  end  of  a  meal,  for  when  taken  at  the 
beginning,  it  appeases  hunger  too  quickly.  The 
rule  should  be  to  eat  frequently,  but  not  too  gener- 
ously, 

DEOPSY. 

Dropsy  is  never  an  independent  disease,  but  only 
a  symptom  of  disease,  and  generally  a  later  symp- 
tom which  may  accompany  disease  of  the  most  dis- 
similar organs,  including  the  heart,  the  lungs,  the 
kidneys,  the  liver,  and  the  blood.  Consequently  it  is 
plain  that  each  individual  case  of  dropsy  requires 
special  consideration,  according  to  the  disease  upon 
which  it  depends,  and  that  a  physician  is  never  jus- 
tified in  regarding  it  as  a  primary  affection.  Any 
considerable  accumulation  of  water,  resulting  from 
the  transudation  of  blood  thinned  by  impaired  nutri- 
tion, inevitably  occasions  inconvenience  and  sys- 
temic disturbances.  Minor  swellings  of  this  descrip- 
tion occur  often  in  the  face  and  feet.  The  cure  of  a 
swollen  face  may  be  assisted  by  means  of  warm  ap- 
plications.    Good  service  may  be  rendered,  in  case  of 


261 


swollen  feet,  by  wearing  elastic  stockings,  or  by 
]:>andaging  the  feet  and  ankles  with  bandages  of  rub- 
ber, flannel,  or  linen.  Prolonged  standing  must  be 
shunned  so  far  as  possible,  and  when  reclining  the 
feet  should  be  elevated.  Inasmuch  as  dropsy  is  a 
sequence  of  bad  nutrition  and  bad  circulation,  it  is 
advisable  to  adhere,  when  nothing  interdicts,  to  a 
substantial  and  strengthening  diet. 


OBESITY. 

Obesity  is  a  frequent  affliction  of  persons  in 
middle  life,  especially  of  those  who  live  quietly  and 
comfortably.  Such  individuals  are  very  apt  to  find 
themselves  increasing  in  flesh  until  they  become 
corpulent.  With  those  who  live  in  complete  -idle- 
ness there  is  but  little  disposition  to  the  accumula- 
tion of  fat,  because  in  such  cases  both  appetite  and 
digestion  are  deficient ;  but  where  fhese  functions 
are  sustained  by  however  slight  an  exertion,  some 
tendency  at  least  exists  to  the  gathering  of  fat. 
Obesity,  when  it  appears,  not  rapidly,  but  gradu- 
ally, presents  no  serious  aspect.  But  in  some  indi- 
viduals there  seems  to  exist  a  personal,  or  even  a 
hereditary  tendency  to  corpulence,  and  then  it  not 
only  gives  to  the  body  an  uncomely  appearance,  but 
may  also  become  the  occasion  of  inconvenience  and 


262 


even  of  dangers,  as  when  it  leads  to  apoplexy.  In 
corpulent  persons  respiration  and  the  action  of  the 
heart  are  likely  to  become  impaired.  This  impair- 
ment is  to  be  attributed  partly  to  the  lessened  energy 
and  the  feebler  contractile  force  of  a  heart  which 
beats  but  faintly,  partly  also  to  the  existence  of  a 
relatively  large  quantity  of  blood  and  to  the  pres- 
sure of  surrounding  organs.  The  same  pressure  of 
surrounding  masses  of  fat  interferes  both  with  res- 
piration and  with  the  beating  of  the  heart.  For, 
upon  their  part,  the  muscles  of  respiration,  filled 
with  fat  and  encased  in  it,  become,  through  the 
consequent  diminution  of  their  contractile  power, 
less  capable  of  fulfilling  their  function,  so  that  the 
respiratory  or  heat-producing  mechanism  of  a  cor- 
pulent man  encounters  the  same  difficulties  as  a 
stove  overloaded  with  fuel.  Quite  as  objectionable 
is  it,  however,  to  be  deficient  in  flesh,  for  such  indi- 
viduals have  too  little  heat-producing  material,  and 
the  processes  of  life  consume  the  nitrogenous  sub- 
stances of  the  weakened  muscular  system  instead  of 
the  fatty  matters  which  are  their  normal  pabulum. 

A  corpulent  man,  if  he  wishes  to  become  healthy 
and  well-proportioned,  must  not  only  rid  himself  of 
his  superfluous  fat,  but  must  also  avoid  any  farther 
accumulation  of  fat.  This  change,  however,  should 
take  place  only  gradually  :  otherwise  the  health 
suffer^.     When  any  one  seeks  to  give  up  fatty 


263 


foods  too  rapidly,  he  is  apt  to  suffer  many  incon- 
veniences, and  especially  to  be  troubled  with  those 
ugly  wrinkles  of  the  skin  which  mark  the  devotees 
of  the  Banting  flesh-cure. 

A  fleshy  man  should  abstain  from  eating  largely 
of  any  fat  article,  of  butter,  sugar,  confections,  pota- 
toes, bread,  the  yolk  of  eggs,  or  the  marrow  of  bones . 
Farthermore,  he  must  not  drink  much  water ;  in  the 
first  place,  because  this  interferes  with  the  circula- 
tion and  with  the  heart's  contractions  by  increasing 
the  amount  of  material  in  circulation  and  so  dilating 
the  blood-vessels ;  in  the  second  place,  because  an 
increase  in  the  amount  of  water  consumed  means  a 
greater  dilution  of  the  food  taken  into  the  stomach 
and  consequently  a  more  thorough  digestion,  whereas 
it  is  politic  for  a  corpulent  person  to  impose  restraints 
upon  the  amount  he  digests,  although  not  upon  the 
satisfaction  of  moderate  hunger.  It  is  better  to  drink 
after  the  digestive  process  is  completed.  If  a  stout 
person  has  a  strong  stomach,  and  can  be  satisfied 
with  few  meals,  it  is  better  for  him,  without  decreas- 
ing his  daily  quantity  of  food,  to  limit  himself  to  as 
few  meals  as  possible,  and  even,  it  may  be,  to  only 
two  in  the  day  :  in  this  way  he  will  digest  less.  A 
thin  man,  of  course,  must  do  the  opposite. 

Bodily  rest  favors  corpulence  to  a  marked  degree, 
particularly  when  accompanied  by  rest  of  the  mind 
and  eraotions,  and  it  is  therefore. to  be  shunned  by 


264 


fleshy  persons.  Personal  activity  should  be  increased 
by  degrees,  and  at  length  the  ponderous  athlete  should 
become  able  to  walk  long  distances,  to  climb  high 
mountains,  should  exercise  in  the  gymnasium,  should 
swim  and  skate,  should  play  games  in  the  open  air, 
should  dance  out  of  doors,  should  saw  wood,  or  work 
in  the  garden.  He  should  not  stop  here,  however,  for 
that  would  only  increase  the  tendency  to  corpulence, 
as  we  sometimes  see  in  the  instance  of  mechanics  or 
laborers  whose  circumstances  enable  them  to  give 
up  work.  Lifelong  exertion  alone  can  be  depended 
upon  to  keep  down  the  inclination  to  fleshiness.  In 
corpulent  persons  the  question  is  properly  not  one  of 
eating,  but  of  exercise.  In  most  cases  the  individual 
does  not  eat  too  much,  but  works  too  little.  Just  as 
sensitiveness  to  cold  may  be  diminished  by  abundant 
and  frequent  eating,  so  the  practice  of  moderation  in 
eating  is  capable  of  diminishing,  if  not  of  wholly  dis- 
pelling, the  oppressiveness  of  a  close  atmosphere  and 
of  the  perspiration  it  induces.  This  is  a  rule  to  be 
remembered  in  winter  as  well  as  in  summer. 


APOPLEXY. 

Apoplexy  is  the  sudden  and  wholly  unexpected 
bursting  of  a  blood-vessel  and  the  resulting  escape 
of  blood  into  the. brain,  as  a  consequence  of  which 


265 


either  immediate  death  occurs,  or  loss  of  conscious- 
ness followed  by  paralysis  of  one  side  of  the  body. 
Such  an  occurrence  is  usually  fatal  after  a  few  hours 
or  days.  The  patient  may,  however,  return  to  con- 
sciousness, and  even  by  degrees  to  the  power  of 
movement.  After  the  reappearance  of  conscious- 
ness the  one-sided  paralysis  very  generally  remains 
during  the  remainder  of  life.  In  certain  cases  mental 
activity  returns  only  to  a  limited  degree,  and  then 
sluggishness  of  intellect,  imbecility,  even  childish- 
ness are  the  results. 

No  warning  is  given  of  the  onset  of  apoplexy. 
The  symptoms  and  the  consequences  of  cerebral 
hemorrhage  depend  upon  the  quantity  of  blood  ex- 
travasated,  upon  the  condition  and  conformation  of 
the  brain-substance  according  to  the  region  into 
which  the  hemorrhage  occurs,  and  upon  the  changes 
which  the  blood-clot  undergoes.  When  only  a  few 
small  blood-vessels  are  torn,  and  the  amount  of 
blood  which  exudes  is  small,  so  that  the  fibres  and 
cells  of  the  brain  suffer  only  slight  pressure,  the  loss  of 
consciousness  and  paralysis  are  also  slight  and  soon 
disappear  when  the  blood  is  reabsorbed.  When  ex- 
tensive hemorrhage  occurs  the  brain  substance  is, 
crushed  and  torn,  so  that  immediate  death  is  the 
more  usual  sequence  ;  but,  when  not,  at  least  exten- 
sive and  permanent  paralysis  ensues.  From  this  it 
is  evident  that  the  results  of  apoplexy  cannot  be  pre- 
dictad.. 


266 


No  particular  bodily  development  is  more  liable 
than  another  to  apoplexy.  There  is  no  so-called 
"apoplectic  habit."  We  know,  however,  that  eld- 
erly persons  with  rigid  blood  -  vessels  are  espe- 
cially subject  to  apoplexy,  as  are  those  who  rapidly 
become  corpulent,  and  chiefly  so  when  much  blood 
has  accumulated  in  the  brain.  Consequently  such 
accumulations  must  be  prevented.  The  existence  of 
unnaturally  rigid  and  brittle  vessels  can  be  detected 
by  feeling  the  temporal  artery,  which  runs  upward 
over  the  head  in  front  of  the  ear,  and  which  under 
these  circumstances  is  always  found  to  be  rigid  and 
tortuous.  By  such  individuals,  as  well  as  by  those 
who  are  corpulent,  everything  must  be  avoided  which 
may  impede  the  return  of  the  blood  from  the  brain 
to  the  neck  and  chest.  Among  hurtful  influences 
we  may  enumerate  tight  clothing  about  the  throat 
and  chest,  coughing,  fatiguing  and  continuous  sing- 
ing, shouting,  blowing  wind-instruments,  continued 
bending,  lifting  heavy  objects,  constipation,  strain- 
ing at  stool  or  in  vomiting,  flatulence,  such  severe 
physical  exertions  as  running,  dancing,  and  swim- 
ming. Similarly  everything  should  be  avoided  which 
tends  to  drive  the  blood  to  the  head,  to  stimulate  the 
brain,  or  to  produce  palpitation  of  the  heart.  The 
latter  category  includes  excessive  indulgence  in 
spirits,  strong  coffee,  or  tea,  overloading  of  the 
stomach,  great  excitements  of  any  description,  ex- 


267 


cessive  mental  or  bodily  effort,  exposure  to  extreme 
heat  or  cold. 

When  any  one  is  attacked  by  apoplexy,  every 
article  of  clothing  should  be  loosened  which  con- 
stricts him  even  in  the  slightest  degree  ;  he  should 
be  placed  in  a  comfortable  position,  rather  sitting 
than  reclining,  with  his  head  raised  and  uncovered 
and  his  feet  hanging  down ;  and  the  air  of  the  room 
should  be  kept  clear  and  cool,  while  special  atten- 
tion is  paid  to  raising  the  temperature  of  his  feet 
and  lowering  that  of  his  head,  meanwhile  averting 
every  disturbance. 


GOUT. 

Gout  is  a  disease  dependent  upon  the  accumula- 
tion in  the  system  of  uric  acid,  one  of  the  excretory 
products  of  which  the  kidneys  are  charged  with  rid- 
ding us.  As  a  rule  those  only  are  attacked  by  it 
who  are  given  to  indulgence  in  rich  foods  or  in  malt 
and  fermented  liquors.  Accordingly  its  severity 
may  be  moderated  by  careful  attention  to  diet.  "  A 
mixed  diet  is  best— a  diet  containing  a  minimum  of 
fatty  matter,  and  in  which  the  proportion  of  album- 
inoids, especially  of  meat,  is  regulated  in  each  indi- 
vidual case  with  due  regard  to  constitutional 
strength,   digestive  power,   occupation,   etc.     As  a 


268 


general  rule,  gouty  persons  should  only  eat  meat 
once  a  day,  at  their  chief  meal.  Smoked  and  salt 
meat  and  fish,  pork,  cheese,  farinaceous  compounds 
containing  much  oily  matter  and  highly  spiced— in- 
deed, all  culinary  delicacies — should  be  absolutely^ 
forbidden.  Eggs  and  dishes  containing  them  should 
be  avoided  as  much  as  possible ;  the  yolk  must  be 
considered  particularly  noxious,  owing  to  the  quan- 
tity of  oily  matter  it  contains.  On  the  other  hand, 
all  kinds  of  soup,  the  more  delicate  varieties  of  meat, 
fish,  shell-fish  (oysters)  in  moderation,  fresh  vege- 
tables, and  fruit,  may  be  recommended. 

^^Tea  and  coffee  should  be  altogether  abjured,  or, 
when  the  patient  cannot  bring  himself  to  do  this, 
should  be  taken  very  weak.  Alcoholic  liquors  should 
never  be  taken  to  quench  thirst,  but  only  as  robor- 
ants,  when  they  are  really  needed ;  the  best  form  is 
then  a  good  red  wine,  neat  or  diluted  with  water,  or 
else  a  light  beer  brewed  with  a  small  proportion  of 
hops  ;  the  fiery  southern  wines,  and  those  which  are 
acidulous,  champagne,  and  heavy  beer  (porter,  etc.), 
must  be  forbidden." 

"  Next  in  importance  to  diet  as  a  hygienic  regula- 
tion in  the  management  of  gouty  patients,"  writes 
Dr.  W,  H.  Draper,  of  New  York,  ^'is  enforced  exer- 
cise. The  axiom  of  Abernethy,  '  to  live  on  a  shilling 
a  day,  and  earn  it,'  comprises  the  philosophy  of  the 
true  relation  of  food  to  work,  and  of  both  to  thQ 


2G9 


highest  development  of  physical  health.  Exercise  is 
to  be  enforced  not  simply  as  a  means  of  securing  an 
active  respiration,  and  thereby  an  abundant  supply 
of  oxygen,  but  also  as  a  means  of  converting  the 
potential  energy  of  the  food  consumed  into  vital 
energy.  In  persons  who  are  incapacitated  by  neur- 
asthenia (nervous  prostration)  or  by  excessive  corpu- 
lence, the  result  of  long  indulgence  in  indolent  and 
luxurious  habits,  it  may  be  necessary  to  resort  to 
passive  exercise  by  rubbing,  massage,  and  electrical 
excitation  in  order  to  secure  the  good  effects  of  vol- 
untary work. 

"Another  hygienic  regulation  of  great  value  in 
the  treatment  of  gouty  discrasia  is  the  promotion  by 
bathing  and  friction  of  the  eliminative  function  of 
the  skin." 


RHEUMATISM. 

Rheumatism  is  a  disease  which  easily  recurs, 
which  is  characterized  by  the  frequent  migration  of 
its  manifestations  from  one  portion  of  the  body  to 
another,  and  which  is  attended  by  exquisite  pain. 
Its  treatment  calls  first  for  confinement  to  bed  in  a 
warm  room,  for  the  drinking  of  hot  water  or  tea, 
and  for  warm  wrappings  to  induce  perspiration.  The 
diseased  portion  should  furthermore  be  encased  in 


270 


hot  poultices,  moist  or  dry.  In  spite  of  this  prelimi- 
nary treatment,  however,  the  precaution  of  sum- 
moning a  physician  ought  never  to  be  omitted,  for 
rheumatism  is  a  very  capricious  and  exhausting  dis- 
ease, and  its  extension  to  nobler  organs,  and  even  to 
the  heart,  is  always  to  be  dreaded. 

**  Occupations  involving  muscular  fatigue  or  ex- 
posure to  sudden  and  extreme  changes  of  temper- 
ature, especially  during  active  bodily  exertion, 
predispose  to  acute  articular  rheumatism ;  hence  its 
frequency  amongst  cooks,  maid-servants,  washer- 
women, smiths,  coachmen,  bakers,  soldiers,  sailors, 
and  laborers  generally.  There  is  some  basis  for  the 
opinion  that  residence  in  damp,  cold  dwellings  pre- 
disposes somewhat  to  rheumatism. 

"Some  relief  may  be  afforded  by  raising  the  af- 
fected limb  and  putting  it  in  such  a  position  as  to 
reduce  the  afflux  of  blood  and  to  relax  the  tendons 
and  ligaments  to  their  utmost.  That  holds  good  for 
the  acute  and  very  painful  form,  while  in  the  less 
painful,  that  is  in  the  chronic  form,  gymnastics  with 
the  affected  part,  massage,  and  other  exercise  render 
good  service.  Lemon  juice  abundantly  partaken  of 
mitigates  the  fever  and  shortens  the  average  dura- 
tion of  the  disease." 

In  this  country  a  manifestation  of  malarial  dis- 
ease not  infrequently  takes  the  form  of  rheumatic 
symptoms,  a  fact  which  explains  the  numerous  in- 


271 


stances  in  which  the  former  disease  is  found  to  yield 
to  anti-rheumatic  remedies.  Rheumatism  may  be 
prevented  by  a  dry  house  and  dry  clothing.  When 
clotliing  becomes  damp,  it  should  not  be  dried  upon 
^the  person,  but  should  be  changed.  Woolen  under- 
wear, so  long  as  it  remains  dry  and  clean,  affords 
better  protection  than  any  other  kind. 


TUBERCULOSIS. 

Tuberculosis  or  '^consumption"  may  occur  in 
almost  any  organ.  It  results  from  a  disproportion 
between  the  acquisition  and  the  loss  of  material. 
Accordingly  the  treatment  should  aim  to  compen- 
sate the  tissue  waste  by  supplying  new  material  for 
tissue  building.  This  may  be  best  accomplished  by 
the  aid  of  a  substantial,  easily-digestible  diet,  good 
air,  and  abundant  rest  for  body,  mind,  and  emotions. 
The  diet  should  include  a  good  deal  of  milk,  eggs, 
roast  meat,  and  other  nuritive  and  strengthening 
foods. 


DISEASES  OF  THE  RESPIRATORY  TRACT. 


COUGH. 


Cough  is  not  a  disease  in  itself,  but  only  a  symp- 
tom which  is  found  to  occur  in  very  many  ailments. 
The  location  of  the  irritation  which  gives  rise  to  a 
cough  may  be  anywhere  in  the  respiratory  tract, 
in  the  larynx,  for  instance,  the  trachea,  or  the 
bronchi,  and  its  occasion  may  reside  in  any  irritat- 
ing substance,  such  as  dust,  smoke,  gas,  liquid,  a 
foreign  body,  or  some  inflammatory  or  ulcerative 
process.  When  produced  by  sharp  food,  the  first 
seat  of  irritation  is  in  the  pharynx,  and  the  irritation 
may  extend,  through  the  agency  of  the  nerves,  to 
adjoining  portions  of  the  respiratory  tract. 

Not  everyone  who  coughs  has  consumption. 
Nevertheless,  no  one  should  let  a  cough  go  without 
attention,  especially  if  it  has  persisted  for  some  time. 
It  is  needless  to  say  that  a  cough  is  most  dangerous 
in  small  children,  and  that  they  should  therefore  be 
carefully  guarded  against  it,  and  immediately  re- 
lieved when  attacked.  The  prevalence  of  coughs 
among  children  in  general  may  be  explained  by  the 

272 


273 


coal  gas  and  other  impurities  with  which  the  atmo- 
sphere of  dwellings  is  so  commonly  contaminated,  as 
well  as  by  many  sudden  changes  of  temperature ; 
for  our  children  are  continually  allowed  to  pass  from 
warm,  even  from  over-heated  living-rooms  into  cold 
sleeping-rooms,  from  hot  school-rooms  into  breezy 
courts,  or  from  gymnasiums  and  dancing-halls,  where 
they  have  been  warmed  through  by  exercise,  into  the 
windy  streets.  Grown  persons  too  acquire  coughs 
by  going  from  uncomfortably  warm  houses,  from 
close  ball-rooms  and  theatres,  often  with  their  bodies 
perspiring,  into  the  cold  air  where,  it  may  be,  a 
chilly  wind  is  blowing.  This  change  of  air,  however, 
is  relatively  less  seldom  to  blame  than  the  sources  of 
irritation  already  referred  to,  and  is  chiefly  used  as 
a  pretext  by  those  who  live  irregularly  and  irration- 
ally to  conceal  the  disastrous  effects  of  smoking, 
drinking,  and  other  excesses. 

In  the  inception  of  a  cough  one  should  diet  him- 
self strictly,  eating  no  other  condiment  than  salt, 
talking  as  little  as  possible,  drinking  no  spirits,  and 
using  no  vinegar.  He  should  take  a  great  deal  of 
warm  milk,  very  soft-boiled  eggs,  and  honey.  His 
dwelling-rooms  should  be  kept  well  ventilated. 
During  the  day,  but  especially  at  night,  he  should 
breathe,  in  a  moderately  large  room  with  closed 
windows  and  doors,  an  atmosphere  impregnated 
with  spirits  of  turpentine.    Such  an  atmosphere  may 


274 


be  created  by  pouring  half  a  tablespoonful  of  spirits 
of  turpentine  into  a  vessel  of  actively  boiling  water. 
In  case  of  a  child,  or  of  a  very  irritable  person,  half 
this  amount  is  sufficient.  Direct  inspiration  of  the 
turpentine  is  not  necessary.  It  very  seldom  happens 
that  an  individual  is  markedly  irritated  by  this 
quantity  of  turpentine.  When  such  is  the  case,  re- 
sort should  be  had  to  a  large  pine  branch  in  a  well 
ventilated  room.  If  the  cough  persists,  no  delay 
should  be  suffered  in  calling  a  physician.  A  similar 
line  of  treatment  holds  good  for  sore  throat  and  for 
nasal  catarrh. 


PULMONARY   CONSUMPTION. 

The  tendency  to  pulmonary  consumption,  or,  in 
other  words,  to  the  reception  and  development  of 
the  bacillus  which  causes  this  disease,  seems  to  de- 
pend in  an  especial  manner  upon  the  constant 
dampness  of  earth  and  air,  and  upon  sudden,  ex- 
treme, and  frequent  alterations  of  temperature.  The 
regions  where  consumption  does  not  occur  are  sig- 
nalized by  remarkable  dryness.  A  dry,  cold  climate, 
or  a  temperate  climate  which  possesses  the  quality 
of  dryness,  appears  to  give  full  protection  against 
consumption,  provided  a  substantial  diet  is  supplied, 
a  diet  not  lacking  in  heat-producing  material ;  while 


275 


the  tropics  predispose  to  this  disease,  especially 
among  natives  of  temperate  countries.  The  pro- 
cesses of  combustion  and  of  tissue-change  do  not 
proceed  rapidly  in  the  lungs  under  tropical  influ- 
ences, but  on  the  contrary  a  free  tissue-waste  takes 
place  through  the  skin  and  urinary  apparatus,  while 
deficiency  of  appetite  and  digestive  inertia  are  apt 
to  interfere  with  the  proper  renewal  of  tissue. 

An  altitude  of  two  thousand  feet  above  the  sea 
may  be  regarded  in  many  localities  as  the  limit  for 
the  occurrence  of  consumption.  Consumption  is 
found  to  bear  a  direct  relation  in  the  frequency  of 
its  inception  to  the  density  of  population  :  hence  its 
frequent  occurrence  in  cities.  Inheritance,  or  rather 
the  tendency  to  inheritance,  has  been  demonstrated 
in  a  large  number  of  instances,  and  this  tendency  is 
chiefly  from  the  father  to  the  daughter  and  from  the 
mother  to  the  son. 

It  may  be  of  service  to  republish  here  a  part  of 
the  article  by  the  present  author,  entitled  "The 
Most  Important  Antisepsis,"  which  appeared  first 
in  the  New  York  Medical  Journal,  and  which  gives 
important  points  in  regard  to  the  treatment  of  con- 
sumption : 

^^The  healthy  human  organism  may  within  cer- 
tain limits  be  considered  an  apparatus  for  self -disin- 
fection. Innumerable  quantities  of  germs  surround, 
pervade,  and  pass  through  it  without  leaving  any 


m 


appreciable  trace  of  their  contact.  Fortunately,  not 
all  of  these  germs  are  virulent,  many  of  them  are 
innocuous,  and  even  the  dangerous  ones  vary  in 
degree  of  harmfulness. 

"  In  the  light  of  recent  bacteriological  researches, 
we  are  justified  in  assuming  that  most  of  the  consti- 
tutional diseases  are  due  to  infection  by  some  char- 
acteristic bacillus,  but  it  would  be  erroneous  to  infer 
that  every  one  of  these  bacilli,  by  its  invasion  of  the 
human  system,  in  each  individual  case  produced  the 
characteristic  systemic  disturbance  of  which  it  is 
known  to  be  the  cause.  Could  all  these  invisible 
hordes  of  tormentors  and  slayers  enter  the  system  at 
the  point  of  attack,  then  our  populous  cities  would 
be  but  vast  hospitals,  and  no  single  individual  would 
reach  the  number  of  years  which  now  constitute  the 
prime  of  life. 

"  A  healthy  and  well-nourished  body  is  endowed 
with  great  powers  of  resistance  to  the  action  of  most, 
if  not  of  all,  species  of  bacilli,  thus  rendering  itself 
aseptic  by  virtue  of  its  own  healthfulness.  A  few 
references  to  actual  experiments  will  suffice  to  show 
the  correctness  of  this  view.  Professor  Traube  ex- 
perimented in  1876  by  injecting  a  quantity  of  pus 
into  healthy  dogs.  After  twenty-four  hours  he  found 
no  trace  of  it  in  the  system ;  his  results,  however, 
were  different  when  the  quantity  was  increased. 
Dr.  Trudeau  inoculated  fifteen  rabbits  with  tubercle 


27' 


bacilli ;  ten  of  them,  which  were  kept  in  damp,  im- 
pure air  and  on  improper  food,  developed  tubercu- 
losis. The  other  five  were  permitted  to  run  about  in 
good,  pure  air,  and  were  well  nourished ;  of  these, 
only  one  died  of  a  resultant  tubercular  affection,  and 
four  remained  well.  The  experiments  of  Brown- 
Sequard,  which  were  made  before  those  of  Dr. 
Trudeau,  yielded  still  better  results,  since  of  all  the 
animals  inoculated  with  the  tubercular  virus,  not 
one  was  lost.  He  ascribed  these  results  to  their 
being  kept  in  a  well-aired  open  place,  supplied  with 
abundant  nutriment. 

^'  In  patients  who  had  only  recently  developed 
symptoms  of  phthisis,  Brown-Sequard,  Stokes,  and 
Blake  aborted  the  disease  by  the  same  treatment  of 
saturating  the  system  with  pure  air  and  good  food. 
It  must  be  apparent,  therefore,  that  the  power  of 
self -disinfection  depends  chiefly  upon  two  factors  : 
1.  Thorough  impregnation  with  the  oxygen  of  the 
air.  2.  Generous  alimentation.  These  agents  must 
be  relied  upon  to  give  to  the  stomach  power  to  digest 
certain  bacilli,  as  well  as  to  the  blood  that  richness, 
vitality,  and  vigor  which  enable  it  to  ward  off  an 
invasion  of  bacterial  foes,  and  by  the  aid  of  which 
they  can  be  most  speedily  repulsed  and  driven  from 
the  system,  even  though  they  have  entered  the  cir- 
culation  at  a  vulnerable  spot.  In  addition  to  these 
two  important  factors,  several  other  hygienic  requi- 


278 


sites  must  not  be  overlooked,  such  as  congenial 
temperature,  sunshine,  clean  dry  soil,  pure  water, 
moderate  exercise,  etc.,  all  of  which  are  valuable  as 
accessories  to  produce  the  full  beneficial  effect  of 
pure  air  and  abundant  food. 

!  ^^The  power  of  self -disinfection  is  greatly  im- 
paired whenever  a  serious  illness,  aggravated  by 
febrile  symptoms,  takes  possession  of  the  body,  but 
it  is  gradually  restored  when  the  illness  subsides. 
Of  all  the  duties  of  the  physician,  none  is  more  im- 
portant than  to  aid  the  prostrate  organism  in  its 
struggle  to  recover  the  lost  power  of  self -disinfec- 
tion, not  only  by  antiseptic  chemicals,  which  are  of 
excellent  service  wherever  their  application  is  admis- 
sible, but  also  by  surcharging  the  system  with  pure 
air  and  nourishing  food»" 

The  author's  views  are  endorsed  by  a  large  num- 
ber of  medical  authorities,  as  by  Dr.  Austin  Flint, 
who  says  :  '^  The  dietetic  instructions  to  a  phthisical 
patient  may  be  summed  up  as  follows  :  eat  of  whole- 
some articles  of  food  whatever  the  appetite  may  dic- 
tate ;  endeavor  to  maintain  and  develop  appetite  and 
relish  for  food  by  the  excitement  of  variety  in  kind 
and  in  preparation ;  eat  whenever  hungry ;  satisfy 
the  appetite  ;  eat  without  any  expectation  of  harm  ; 
do  not  hastily  attribute  an  indigestion  to  any  partic- 
ular articles  of  diet ;  incur  the  risk  of  over-feeding 
rather  than  the  greater  evil  of  under-feeding. 


279 


^*  Outdoor  life  and  exercise  are  of  the  greatest  im- 
portance. Indoor  life  and  sedentary  habits,  if  not 
factors  in  an  acquired  cachexia,  undoubtedly  favor 
it.  Students,  clergymen,  and  men  of  leisure  should 
systematically  devote  a  fair  proportion  of  time  to 
exercise  in  the  open  air,  and,  as  far  as  practicable, 
the  exercise  should  involve  recreation.  It  is  need- 
less to  say  that  the  importance  of  change  is  as 
applicable  to  women  as  to  men.  Caution  is  some- 
times necessary  not  to  carry  muscular  exercise  to  an 
injurious  extreme.  If  carried  to  the  extent  of  pro- 
ducing great  fatigue  or  exhaustion,  it  is  debilitating 
instead  of  invigorating.  Exercise  within  doors,  al- 
though much  less  useful  than  when  taken  in  the 
open  air,  is  nevertheless  useful.  Gymnastic  exercises 
may  be  recommended  when  other  measures  which 
are  to  be  preferred  are  not  available.  They  are  in- 
ferior to  horseback-riding,  hunting,  mountain-climb- 
ing, etc.  An  increased  expansion  of  the  chest  is 
apparently  a  desirable  effect  of  exercise. 

*^  Phthisical  patients  are  no  more — and  perhaps 
less — liable  to  catch  cold  than  persons  in  health. 
There  is  no  ground  for  the  great  scrupulousness  with 
which  phthisical  patients  avoid  the  cold  and  night 
air,  although  out-of-door  life  in  the  daytime  is  to  be 
preferred.  Every  practitioner  has  known  of  cases  in 
which  some  remarkable  changes  of  habits  as  regards 
out-of-door  life  and  exercise  have  led  to  recovery, 


280 


such  as  performing  long  journeys  on  horseback  or 
on  foot,  accomi)anying  expeditions  which  involved 
camping  in  the  open  air. 

^'  The  supposed  liability  to,  and  danger  of,  catching 
cold  often  leads  phthisical  patients  to  wear  an  over- 
plus of  clothing.  When  they  strip  for  an  examina- 
tion of  the  chest,  not  infrequently  they  remove  two 
or  three  undershirts,  a  woolen  or  fur  chest-protector, 
and  sometimes  in  addition  an  oiled-silk  jacket.  The 
body  is  kept  in  constant  perspiration  by  these  articles. 
They  occasion  not  only  discomfort,  but  debility.  A 
single  word  expresses  the  governing  principle  iti 
clothing,  namely,  comfort.  Articles  of  dress  should 
be  so  adapted  to  the  seasons  and  to  changes  of  tem- 
perature as  to  secure  comfort.  This  maxim  applies 
to  persons  affected  with  phthisis  as  well  as  to  those 
in  health. 

"  The  Prophylaxis  against  phthisis  must  date 
from  birth.  An  infant  should  not  nurse  a  mother 
who  is  consumptive,  or  whose  milk  is  of  poor  quality. 
Care  is  to  be  observed  in  the  selection  of  wet-nurses. 
All  the  various  articles  which  are  sold  under  the 
name  of  infants'  food  should  be  discarded.  Many  of 
these  are  fraudulent;  that  is,  they  are  not  what  they 
purport  to  be.  There  is  need  of  much  caution  respect- 
ing the  purity  of  milk,  especially  in  cities.  Much 
harm  is  not  infrequently  done  by  over-care  in  chil- 
dren's diet— that  is,  by  denying  articles  which  they 


281 


crave,  and  restricting  them  to  those  which  they  do 
not  like.  Not  infrequently,  from  undue  caution  the 
quantity  of  food  is  restricted,  and  children  suffer 
from  insufficient  alunentation;  this  more  likely  to 
occur  in  our  country  among  the  wealthy  than  among 
the  poorer  classes. 

''  Occupying  the  same  bed  with  phthisical  patients 
and  sleeping  in  the  same  room  are  objectionable. 
Care  should  be  taken  to  exclude  from  the  table  the 
meat  of  tuberculous  animals.  In .  addition  to  the 
purity  of  milk  in  other  regards,  it  should  be  ascer- 
tained that  the  supply  is  not  from  cows  affected  with 
tuberculous  disease.  The  ventilation  of  apartments 
occupied  by  phthisical  patients  should  be  attended 
to  with  reference  to  the  possibility  of  the  disease  be- 
ing communicated  by  the  inhalation  of  particles  of 
tubercle;  and  it  may  not  be  a  needless  precaution  to 
introduce  a  disinfectant  into  the  vessels  which  re- 
ceive the  matter  expectorated. " 

'^  The  Health  Department  of  New  York  City  have 
formulated  the  following  rules,  based  upon  the  con- 
clusions arrived  at  by  a  committee  of  physicians  and 
pathologists  of  that  city:  Pulmonary  tuberculosis 
(consumption)  is  directly  communicated  from  one 
person  to  another.  The  germ  of  the  disease  exists 
in  the  expectoration  of  persons  afflicted  with  it. 
Tuberculosis  is  commonly  produced  in  the  lungs 
(which  are  the  organs  most  frequently  affected)  by 


282 


breathing  air  in  which  living  germs  are  suspended 
as  dust.  The  material  which  is  coughed  up,  some- 
times in  large  quantities,  by  persons  suffering  from 
consumption  contains  these  germs  often  in  enormous 
numbers.  This  material  when  expectorated  fre- 
quently lodges  in  places  where  it  dries,  as  on  the 
street,  floors,  carpets,  handkerchiefs,  etc.  After  dry- 
ing in  one  way  or  another,  it  is  very  apt  to  become 
pulverized  and  float  in  the  air  as  dust. 

"By  observing  the  following  rules  the  danger  of 
catching  the  disease  will  be  reduced  to  a  minimum: 

"  1.  Do  not  permit  persons  suspected  to  have  con- 
sumption to  spit  on  the  floor  or  on  clothes  unless  the 
latter  be  immediately  burned.  The  spittle  of  per- 
sons suspected  to  have  consumption  should  be  caught 
in  earthen  or  glass  dishes  containing  the  following 
solution :  corrosive  sublimate,  1  part ;  water,  1,000 
parts. 

"2.  Do  not  sleep  in  a  room  occupied  by  a  person 
suspected  of  having  consumption.  The  living  rooms 
of  a  consumptive  patient  should  have  as  little  furni- 
ture as  practicable.  Hangings  should  be  especially 
avoided.  The  use  of  carpets,  rugs,  etc.,  ought 
always  to  be  avoided. 

"3.  Do  not  fail  to  wash  thoroughly  the  eating 
utensils  of  a  person  suspected  of  having  consump- 
tion, a^s  soon  after  eating  as  possible,  using  boiling 
water  for  the  purpose. 


283 


"4.  Do  not  mingle  the  unwashed  clothing  of  con- 
sumptive patients  with  similar  clothing  of  other 
persons. 

"5.  Do  not  fail  to  catch  the  bowel  discharges  of 
consumptive  patients  with  diarrhoea  in  a  vessel  con- 
taining corrosive  subUmate  1  part,  water  1,000  parts. 

"  Q.  Do  not  fail  to  consult  the  family  physician 
regarding  the  social  relations  of  persons  suffering 
from  suspected  consumption. 

"7.  Do  not  permit  mothers  suspected  of  having 
consumption  to  nurse  their  offspring. 

"8.  Household  pets  (animals  or  birds)  are  quite 
susceptible  to  tuberculosis;  therefore  do  not  expose 
them  to  persons  afflicted  with  consumption;  also,  do 
not  keep,  but  destroy  at  once,  all  household  pets 
suspected  of  having  consumption,  otherwise  they 
may  give  it  to  human  beings. 

''9.  Do  not  fail  to  cleanse  thoroughly  the  floors, 
walls,  and  ceilings  of  the  living  and  sleeping-rooms 
of  persons  suffering  from  consumption  at  least  once 
in  two  weeks." 

To  this  we  would  add  that  it  ought  to  be  custom- 
ary for  all,  and  especially  for  the  sick,  instead  of 
expectorating  into  the  handkerchief,  to  make  use  of 
tissue-paper,  which  is  to  be  carried  constantly  in  a 
receptacle  specially  provided  for  the  purpose,  and 
which  must  be  burned  at  a  convenient  opportunity. 
Positive  instructions  should  be  given  to  persons  suf-. 


284 


f ering  from  cough  never  to  swallow  their  expectora- 
tions, on  account  of  the  danger  of  self-infection  pro- 
ducing tuberculosis  of  the  intestines. 

An  undoubted  method  of  contagion,  and  one  to  be 
discouraged  under  all  circumstances,  lies  in  kissing 
the  lips  of  phthisical  individuals. 

The  air  breathed  by  a  consumptive  should  always 
be  pure  and  dry  and  should  be  free  from  irritating 
particles.  Care  should  be  taken  not  to  constrict 
the  lungs  and  chest  either  by  wearing  tight-fitting 
garments,  or  by  bending  forward  when  seated ;  but 
on  the  contrary  an  effort  should  be  made  to  secure 
the  expansion  of  these-  organs  by  suitable  gymnastics 
and  other  physical  exercise.  Such  efforts  at  the  ex- 
pansion of  the  lungs  must  be  undertaken,  however, 
under  many  precautions  and  restrictions,  and  never 
under  any  circumstances  when  the  patient  is  dis- 
posed to  be  feverish. 

Recent  investigations  have  demonstrated  that  the 
bacteria  of  consumption,  like  those  of  the  malarial 
diseases,  are  especially  numerous  upon  and  within 
the  ground,  and  that  bad  drainage  is  no  unimportant 
factor  in  the  production  of  the  disease.  An  especial 
reason  why  no  one  should  use  uncooked  milk  is  that 
it  may  be  the  carrier  of  consumption,  as  it  is  at 
present  known  to  be  of  other  grave  diseases. 


285 


CROUP  AND  DIPHTHERIA. 

Croup  and  diphtheria  are  very  dangerous  dis- 
eases, whose  proper  seat  is  the  pharynx,  but  which 
frequently  show  a  marked  tendency  to  invade  the 
larynx.  They  are  easily  recognized  by  the  grayish- 
white,  mortar-like  exudation  which  appears  in 
patches  upon  a  deeply  congested  mucous  membrane. 
The  more  completely  the  mucous  membrane  of 
the  mouth  and  throat  have  been  subjected  to  the 
ravages  of  catarrh,  so  much  the  more  readily  will 
the  contagion  be  received  and  diffused  within  it.  On 
this  account  those  who  are  affected  with  catarrh  of 
the  nose,  mouth,  or  throat  should  take  especial  care 
against  infection  ;  and  for  the  same  reason  no  diph- 
theritic patient  should  by  any  means  allow  his  throat 
to  be  cauterized,  for  this  injures  the  mucous  mem- 
brane and  spreads  the  germs  of  the  disease. 

Inasmuch  as  diphtheria  is  a  very  virulent  disease, 
the  utmost  care  should  be  taken  in  every  instance  to. 
protect  oneself  against  it.  Whoever,  for  instance, 
needs  to  examine  the  throat  of  a  diphtheritic  patient  ■ 
should  close  his  own  mouth  tightly  and  stop  his 
nostrils  with  cotton.  After  the  inspection  he  should 
wash  his  hands  with  a  solution  of  spirits  of  turpen- 
tine or  of  boracic  acid.  The  sputum  of  the  patient 
should  be  disinfected  with  scrupulous  care.     Drink^ 


28A 


ing-Tesseis,  spoons  and  linen  from  the  patient  must 
not  be  used  by  healthy  individuals.  One  of  the 
greatest  dangers  of  infection  lies  in  kissing  the 
patient,  and  this  must  be  positively  interdicted. 
Children  should  be  removed  from  a  house  where 
diphtheria  exists,  or  at  least  completely  separated 
from  their  sick  companions. 

Tonsillitis,  with  great  enlargement,  and  some- 
times with  induration  of  the  tonsils,  is  attended  by 
difficulty  in  breathing,  by  snoring,  and  at  times  by 
difficult  hearing.  The  tonsils  are  apt  to  become 
permanently  enlarged,  especially  after  several  recur- 
rences. In  this  case  a  portion  of  each  tonsil  should 
be  removed,  an  operation  attended  by  little  pain  or 
inconvenience  when  a  suitable  instrument  is  used. 


ASTHMA. 

Asthma  is  a  difficulty  in  breathing,  which  comes 
on  suddenly  with  convulsive  respirations.  In  chil- 
dren, when  not  dependent  upon  some  other  disease, 
asthma  consists  apparently  in  a  convulsive  narrow- 
ing of  the  aperture  between  the  vocal  cords,  a 
phenomenon  not  yet  sufficiently  explained  by  phy- 
sicians. Such  a  condition  should  be  treated  by 
raising  the  child  up,  and  sprinkling  its  chest  and 


2Sl! 


back  with  cold  water,  rubbing  tbe  back,  administer- 
ing enemata  of  warm  water  and  vinegar,  rubbing 
and  brushing  the  pahns  of  the  hands  and  the  soles  of 
the  feet,  by  pushing  one's  finger  far  down  the  child's 
throat  so  as  to  cause  coughing  and  vomiting,  by 
inducing  sneezing  and  exciting  the  sense  of  smell, 
and  by  plunging  the  child  into  a  warm  bath. 

In  adults  asthma  is  as  a  rule  a  symptom  which 
indicates  an  unnatural  enlargement  of  the  air-cells 
of  the  lungs.  It  may  occur,  however,  as  a  nervous 
spasm  of  the  bronchioles,  and  it  even  at  times  ac- 
companies other  lung  diseases,  some  spasmodic 
nervous  disease  perhaps.  In  very  fleshy  persons, 
particularly  among  those  who  indulge  in  liquors, 
asthma  seems  to  be  dependent  upon  fatty  deposits 
in  the  heart  and  respiratory  muscles,  and  therefore 
treatment  must  be  directed  against  obesity.  !N"ot  in- 
frequently too,  in  those  affected  with  heart  disease, 
consumption,  spinal  curvature,  chlorosis,  and  similar 
diseases,  the  name,  asthma,  is  applied  to  the  attend- 
ant difficulty  of  breathing. 

IS'othing  can  give  certainty  as  to  the  cause,  when 
an  asthmatic  attack  occurs  or  when  great  difficulty 
in  breathing  arises,  excepting  careful  physical  ex- 
amination. In  order  to  shorten  an  attack  of  asthma, 
after  loosening  all  tight  clothing,  we  may  try  sprink- 
ling cold  water  upon  the  chest  and  back,  tickling 
the  throat  to  induce  vomiting,  inhalation  of  tresn 


^88 


air,  ether,  or  chloroform,  the  administration  of 
chloral  hydrate,  the  hypodermic  injection  of  mor- 
phine, warm  baths  to  hands  and  feet,  the  use  of 
enemata,  and  friction  upon  the  back.  Sometimes 
the  administration  of  fruit  ices  or  of  cracked  ice 
does  good  service. 


HAY  FEVER 

Hay  fever  is  a  catarrh  of  the  respiratory  tract, 
which  is  often  attended  by  severe  asthmatic  symp- 
toms, which  seems  to  result  from  the  irritation 
caused  by  the  pollen  of  one  or  another  plant,  and 
which  visits  the  individual  only  at  the  season  of 
year  when  that  particular  plant  is  in  flower.  Rag- 
weed is  the  familiar  plant  to  whose  influence  the 
disease  is  most  frequently  ascribed  in  America,  and 
as  a  consequence  most  hay  fever  sufferers  are  exempt, 
if  they  pass  the  period  of  attack  in  some  region 
where  this  weed  does  not  grow.  Such  localities  are 
found  in  the  White  Mountains  of  ISTew  Hampshire, 
the  lake  region  of  Maine,  in  California,  in  Florida 
and  parts  of  Georgia,  in  the  copper  region  south  of 
Lake  Superior,  and  in  most  sections  of  Canada.  In 
general  an  altitude  of  more -than  seven  hundred  feet 
secures  exemption;  but  some  patients  are  benefited 
only  by  a  residence  upon  the  seashore  ;  and  all  are 


289 


free  while  upon  the  ocean,  no  doubt  because  the  of- 
fending vegetation  is  necessarily  far  removed. 

In  the  majority  of  cases  this  disease  obstinately 
resists  medical  treatment.  Much,  however,  may 
often  be  accomplished  by  way  of  palhation,  and  the 
treatment  of  other  complaints  exercises  a  beneficial 
influence  upon  hay  fever.  Regularity  of  life,  plain- 
ness in  diet,  and  especially  the  following  of  outdoor 
pursuits  are  of  assistance  in  moderating  the  parox- 
ysms. The  severer  symptoms  may  be  reheved  by 
such  measures  as  are  advised  in  case  of  asthma. 

Disagreeable  Breath  is  very  often  occasioned  by 
uncleanly  conditions  of  the  mouth,  due  to  the  pres- 
ence of  particles  of  food  between  the  teeth  or  in  cav- 
ities of  the  teeth  themselves.  Hollow  teeth  should 
be  frequently  cleaned  and  filled  by  a  dentist.  The 
teeth  should  be  carefully  brushed  every  day,  and 
especially  after  the  last  meal  of  the  day,  with  alco- 
hol or  cologne  when  possible,  or  with  a  rosewater 
solution  of  permanganate  of  potash,  or  a  solution  o 
half  a  teaspoonful  of  spirits  of  turpentine  in  a  glass 
of  water.  The  snuffing  up  of  such  a  solution  may 
also  be  found  serviceable  against  bad  odors  from  the 
nose. 


■p 


DISEASES  OF  THE  DIGESTIVE  TRACT. 


DYSPEPSIA. 

Dyspepsia  signifies  difficult  digestion.  When  a 
disturbance  of  digestion  occurs,  either  as  a  result 
of  general  weakness,  or  in  consequence  of  a  catarrh- 
al condition  of  the  stomach  induced  by  eating  food 
too  *cold  or  too  hot,  by  alcohol,  by  spices,  or  by  decay- 
ing food,  we  know  that  the  formation  of  pepsin  is  in 
some  way  interfered  with.  In  such  cases,  since  the 
efficiency  of  digestion  depends  largely  upon  the 
abundance  of  pepsin,  it  is  desirable  to  administer  ar- 
tificial pepsin.  When  the  indigestion  is  of  recent 
origin,  it  is  oftentimes  sufficient  to  evacuate  an  over- 
loaded stomach  by  vomiting.  If,  however,  the  food 
eaten  has  already  passed  into  the  intestine,  a  laxa- 
tive should  be  given. 

A  symptom  which  accompanies  dyspepsia  in  the 
majority  of  instances  is  heartburn,  with  which  is 
commonly  associated  a  spasmodic  sensation  at  the 
pit  of  the  stomach,  attended  with  the  vomiting:  of 
water.  In  most  instances,  too,  eructations  take  place 
frequently  of  a  clear,  watery  fluid,  having  a  sour  or 

290 


m 


rancid  taste.  Among  the  causes  to  which  heartburn 
may  be  due  are  the  use  of  fatty  and  rancid  articles 
of  food,  the  eating  of  foods  that  are  sour  or  that 
readily  turn  sour,  the  presence  of  stomach  affections 
with  increased  secretion  of  acid  gastric  juice,  the 
formation  of  lactic  and  butyric  acids  in  the  stomach 
by  an  abnormal  transformation  of  starchy  elements, 
and,  first  perhaps  in  frequency,  chronic  catarrh  of 
the  gastric  mucous  membrane  in  drunkards.  For 
the  relief  of  this  distressing  symptom  treatment 
must  in  the  first  place  be  directed  to  the  neutraliza- 
tion of  the  acid  by  giving  after  each  meal  a  pinch  of 
magnesia  or  of  bicarbonate  of  soda,  and  in  the 
second  place  to  the  improvement  of  the  mucous 
membrane  of  the  stomach  by  means  of  strict  diet 
and  by  drinking  half  a  glass  of  hot  water  before 
each  meal.  The  principal  object  of  treatment  is  not 
simply  to  carefully  eschew  every  indigestible  sub- 
stance, but,  still  farther,  to  avoid  the  causes  of 
acidity  and  fermentation.  Cold  meats  are  generally 
found  more  easy  of  digestion  than  warm  ones. 

It  may  not  be  thought  out  of  place  to  say  here 
that  many  investigators  of  the  present  time  hold  the 
belief  that  intestinal  fermentation  produces  certain 
chemical  gases  and  alkaloids,  which,  when  absorbed 
into  the  blood,  make  a  profound  impression  upon  the 
nervous  system.  It  is  maintained  that  their  absorp- 
tion practically  introduces  a  poison  into  the  blood. 


292 


followed  by  symptoms  of  disease  which  are  vaguely 
attributed  to  various  conditions.  Brunton  well  said 
that  ^'perhaps  we  are  not  yet  sufficiently  alive  to 
the  important  results  produced  by  the  absorption 
from  the  intestinal  canal  of  substances  generated  in 
it  by  fermentation  or  imperfect  digestion.  We  re- 
cognize the  danger  of  breathing  gas  from  a  sewer, 
but  probably  we  do  not  sufficiently  realize  that 
noxious  gases  may  be  produced  in  the  intestine,  and, 
being  absorbed  into  the  circulation,  may  produce 
symptoms  of  poisoning. " 

^^  There  is  not  a  disturbed  condition  of  life,  ex- 
trinsic or  intrinsic,  that  may  not  contribute  to  indi- 
gestion. In  some  cases  it  may  be  the  effect  of  hot 
and  enervating  climates  ;  in  others  the  alterations  in 
the  elementary  constituents  of  the  blood  may  be 
apparent ;  while  in  still  others  the  cause  may  be 
exhausting  discharges,  hemorrhages,  profuse  sup- 
puration, venereal  excesses,  sedentary  occupations, 
and  long  continued  mental  and  moral  emotions. 
The  inordinate  mental  activity,  the  active  competi- 
tions of  life,  the  struggle  for  existence,  the  haste  to 
get  rich,  the  disappointments  of  failure — all  con- 
tribute to  this  end.  The  general  tendency  of  Ameri- 
can life  is  also  in  the  direction  of  a  highly  developed 
and  morbidly  nervous  system,  and  functional  dys- 
pepsia is  a  natural  sequence  of  this. 

"Age  also  predisposes  to  weak  digestion.    The 


293 


stomach  becomes  weak  as  age  advances  in  common 
with  all  the  functions  of  the  body,  and  consequent 
upon  this  weakness  there  is  diminished  excitability 
of  the  gastric  nerves,  with  diminished  muscular 
action  of  the  walls  of  the  stomach  and  deficient 
secretion  of  the  gastric  juice.  Chronic  structural 
changes  are  also  apt  to  occur  in  advanced  life. 

"Anaemia  is  a  common  predisposing  cause  of 
indigestion.  Indeed,  as  a  widely  prevailing  patho- 
logical condition  few  causes  stand  out  so  prominent. 
It  affects  at  once  the  great  nutritive  processes,  and 
these  in  turn  disturb  the  functional  activity  of.  all 
the  organs  of  the  body.  Not  only  are  the  gastric 
and  intestinal  glands  diminished  in  their  functional 
activity  by  impoverished  or  altered  blood,  but  the 
movements  of  the  stomach  are  retarded  by  weak- 
ened muscular  action.  Nothing  will  more  promptly 
restore  the  digestive  capacity  in  such  cases  than 
good,  healthy,  well  oxidized  blood. 

'^Exhaustion  of  the  nerves  strongly  predisposes 
to  the  atonic  forms  of  dyspepsia.  This  form  of  indi- 
gestion is  peculiar  to  the  ill  fed  and  badly  nourished. 
It  follows  in  the  wake  of  privations  and  want,  and 
is  often  seen  in  the  peculiarly  careworn  and  sallow 
classes.  In  this  dyspepsia  of  exhaustion  the  solvent 
power  of  the  stomach  is  so  diminished  that,  if  food 
is  forced  upon  the  patient,  it  is  apt  to  be  followed  by 
flatulence,  headache,  uneasy  or  painful  sensations 


2U 


in  the  stomach,  and  sometimes  by  nausea  and  diar- 
rhoea. It  is  best  treated  by  improving  in  every  pos- 
sible way  the  general  system  of  nutrition,  and  by 
adapting  the  food,  both  in  quantity  and  quality,  to 
the  enfeebled  condition  of  the  digestive  powers. 

"  But  of  all  predisposing  causes  of  dyspepsia  de- 
ficient gastric  secretion,  with  resulting  fermentation 
of  food,  is  perhaps  the  most  prevalent. 

"  Of  exciting  causes  errors  of  diet  are  amongst 
the  most  constantly  operative,  and  of  these  errors 
excess  of  food  is  doubtless  the  most  common  and 
hurtful.  The  use  of  indigestible  and  unwholesome 
food  entails  somewhat  the  same  consequences.  This 
may  consist  in  the  use  of  food  essentially  unhealthy 
or  indigestible,  or  made  so  by  imperfect  preparation. 
Certain  substances  taken  as  food  cannot  be  dissolved 
by  the  gastric  or  intestinal  secretions  :  the  seeds, 
the  skins  and  rinds  of  fruit,  the  husks  of  corn,  and 
bran,  and  gristle,  and  elastic  tissue,  as  well  as  hairs 
in  animal  food,  are  thrown  off  as  they  are  swal- 
lowed, and,  if  taken  in  excess,  they  mechanically 
irritate  the  gastro-intestinal  mucous  membrane,  and 
excite  symptoms  of  acute  dyspepsia,  and  not  infre- 
quently give  rise  to  pains  of  a  griping  character  ac- 
companied by  diarrhoea.  The  injurious  consequences 
of  overfeeding  may  finally  correct  themselves  by 
destroying  the  capacity  of  the  stomach  to  digest  the 
food;  but  on  the  other  hand  the  weak  stomach  fe 


395 


not  infrequently  made  weaker  by  severely  restricted 
regimen,  and  especially  is  this  the  case  with  mental 
workers.  Men  who  toil  with  their  brains  rather 
than  their  muscles,  whether  dyspeptic  or  not,  re- 
quire good,  easily  digested,  mixed  diet. 

''  Haste  in  eating,  with  imperfect  mastication,  is  a 
common  cause  of  indigestion  in  this  country.  Masti- 
cation is  the  first  step  in  the  digestive  process.  It  is 
important,  therefore,  that  we  have  good  teeth  and  that 
we  take  time  to  thoroughly  masticate  our  food,  for 
by  so  doing  we  prepare  it  for  being  acted  upon  by 
the  juices  of  the  stomach.  Time  is  also  necessary,  in 
order  that  the  salivary  secretion  may  be  incorporated 
with  the  alimentary  substances.  Haste  in  eating  is 
one  of  the  American  vices.  It  grows  out  of  the 
temperament  of  our  people."  So  says  Dr.  S.  G. 
Armour. 

"Irregularity  in  the  intervals  between  meals, 
such  as  taking  a  meal  only  once  in  twenty-four 
hours,  or  taking  food  before  the  preceding  supply 
has  been  digested,  is  another  fruitful  source  of 
indigestion. 

"  To  the  most  prominent  causes  of  indigestion 
already  alluded  to  may  be  added  the  habit  of  spirit 
drinking,  especially  the  habit  of  taking  alcohol  un- 
diluted on  an  empty  stomach.  All  organs  associ- 
ated with  each  other  in  their  physiological  functions 
are  apt  to  become  associated  in  morbid  action.    And 


296 


first  in  the  order  of  importance  in  such  association  is 
the  liver.  The  pancreas  is  also  closely  associated 
with  the  stomach,  and  its  secretion  is  of  essential 
value  in  the  digestive  process. 

*'  That  morbid  states  of  the  intestinal  tract  occupy 
a  prominent  place  in  the  etiology  of  dyspepsia  is 
also  a  well-recognized  clinical  fact.  Indeed,  consti- 
pation of  the  bowels  is  an  almost  universal  accom- 
paniment of  deranged  digestion,  and,  when  persistent 
for  years,  it  is  apt  to  lead  to  the  most  disastrous 
consequences. 

^'  No  single  measure  has  such  marked  influence 
on  the  digestive  powers  of  the  stomach  as  syste- 
matic, well-regulated  muscular  exercise  in  the  open 
air,  and  especially,  if  the  exercise  be  accompanied 
by  a  cheerful  mental  state.  For  this  reason  outdoor 
sports  are  of  benefit.  This  is  often  best  accomplished 
by  travel,  when  practicable,  in  foreign  countries 
where  everything  will  be  nove]  and  new  and  calcu- 
lated to  lead  the  patient  away  from  himself.  Get 
him  to  travel,  says  Watson,  in  search  of  his  health, 
and  the  chances  are  in  favor  of  his  finding  it.  We 
have  the  authority  of  Sir  James  Johnson  also  for 
saying  that  no  case  of  purely  functional  dyspepsia 
can  resist  a  pedestrian  tour  over  the  Alps." 

Spasm  of  the  Stomach  is  evinced  by  a  pain, 
sometimes  of  one  description,  sometimes  of  another. 


297 


but  always  very  severe,  which  frequently  extends  to 
the  back,  and  which  may  occur  either  on  an  empty 
or  on  a  full  stomach.  It  is  often  attended  or  fol- 
lowed by  an  Ulcer  of  the  Stomach,  or  is  the  conse- 
quence of  the  cicatrization  of  such  a  sore. 

Diet  is  of  the  greatest  importance.  The  patient 
should  not  partake  of  cold,  irritating,  distending,  or 
indigestible  foods  or  drinks,  avoiding  for  instance 
iced  water  and  beer,  pepper,  mustard,  spirits,  and 
vegetables.  On  the  contrary  we  may  recommend 
such  aliments  as  milk,  not  sweet,  but  sour ;  butter- 
milk ;  palatable  meatbroths,  with  an  egg  beaten  in 
each  cup,  yolk  and  white  together;  the  juice  of 
tender  meat  expressed  with  a  lemon  squeezer ;  well- 
strained  gruel,  thin  or  thick,  of  oats,  rice,  or  barley ; 
stale  white  bread  or  biscuits  softened  in  coffee,  tea,  or 
chocolate ;  the  pancreas  and  brain  of  slaughtered 
animals.  It  is  desirable  to  drink  a  glass  of  warm 
water  several  times  a  day. 


SEASICKNESS. 

Seasickness  is  a  disease  of  an  extremely  disagree- 
able and  tormenting  character,  which  completely 
stirs  up  the  system,  but  which  is  at  the  same 
time  nearly  always  free  from  danger.  It  owes  its 
origin  to  the  combined  influence  of  various  circum- 


298 


stances  incident  to  a  sea  voyage,  prominent  among 
them  the  change  of  air  and  the  oscillation  of  the 
vessel.  The  air  between  decks  is  especially  prone 
to  affect  one  unfavorably,  and  particularly  in  stormy 
weather,  when  the  doors  and  ports  (the  windows  of 
the  vessel)  are  closed  and  the  air  is  consequently 
contaminated  by  vapors  arising  from  cooking,  by 
the  smell  of  the  machinery,  and  by  exhalations  from 
human  bodies,  from  the  cargo,  from  the  ropes,  and 
from  bilgewater.  Moreover,  even  the  pure  external 
air,  especially  when  the  ship  is  rolling,  is  of  a  differ- 
ent density  to  the  air  on  land,  and  may  also  produce 
the  symptoms  of  seasickness.  Just  as  the  atmo- 
sphere in  the  high  passes  of  the  Cordilleras,  the 
Himalayas,  and  other  lofty  mountains,  in  conse- 
quence of  the  reduced  atmospheric  pressure,  occa- 
sions an  alteration  in  the  circulation  of  the  blood, 
and  consequently  in  the  amount  of  nutriment  fur- 
nished by  the  blood  to  the  brain ;  so  the  air  of  the 
ocean,  by  virtue  of  its  altered  density,  produces  oc- 
casional irregularities  in  the  circulation  and  thereby 
in  the  condition  of  the  brain  and  other  organs,  caus- 
ing headache,  dizziness,  nausea,  and  vomiting.  Sea- 
sickness farthermore  attacks  the  lower  animals,  as 
well  as  men,  both  upon  the  sea  and  upon  high  moun- 
tains. 

The  theory  advanced  in  a  paper  on  seasickness 
read    before   the  Academy    of   Science  in  Vienna 


299 


several  years  ago,  that  the  maiady  is  due  to  the  con- 
stant changes  of  equihbrium,  has  much  in  its  favor, 
but  at  the  same  time  we  should  not  lose  sight  of  the 
influence  exercised  by  a  change  in  the  density  of 
the  air.  The  effect  of  sudden  change  of  density 
may,  for  instance,  be  experienced  in  the  quick  move- 
ment of  an  elevator,  which  causes  a  sensation 
exactly  like  the  early  effects  of  slight  seasickness. 
In  a  precisely  similar  way  the  atmospheric  pressure 
is  varied  by  the  pitching  and  rolling  of  a  vessel. 
The  air  may  also  be  rarified  by  passing  winds  and  by 
the  current  of  air  produced  by  the  quick  movement 
of  the  vessel.  But  at  all  times  the  air  between  decks 
is  more  dense  than  the  outside  air. 

Perhaps  the  so-called  Caisson  Disease,  described 
by  Dr.  Andrew  H.  Smith  of  New  York,  may  be 
found  to  throw  some  light  upon  this  subject,  inas- 
much as  it  has,  up  to  a  certain  point,  a  similar  etiol- 
ogy and  similar  symptoms  to  seasickness.  Persons 
exposed  for  a  considerable  time  to  a  greatly  in- 
creased atmospheric  pressure  are  liable,  after  the 
pressure  is  removed,  to  certain  morbid  effects,  which 
comprise  what  is  known  as  the  caisson  disease.  It 
is  observed  principally  in  those  employed  in  subma- 
rine operations  by  the  aid  of  compressed  air,  and  who 
labor  for  hours  together  in  what  is  termed  by  engi- 
neers a  caisson. 

In  Dr.  Smith's  view  the  explanation  is  to  be  found 


300 


in  the  altered  condition  of  the  circulation,  which  re- 
sults first  from  increased  pressure  upon  the  surface 
of  the  body,  and  then  from  the  sudden  removal  of 
that  pressure.  While  the  workman  is  in  the  caisson 
the  blood  is  driven  from  the  peripheral  vessels 
toward  the  interior  of  the  body,  where  the  pressure 
is  less  than  at  the  surface.  If,  now,  the  external 
pressure  is  suddenly  removed,  what  will  be  the  re- 
sult ?  Vessels  which  have  been  compressed  and 
almost  emptied  of  blood  will  now  offer  new  channels 
through  which  the  blood  can  rush,  and  vessels  over- 
crowded with  blood  will  have  the  current  within 
them  slowed  almost  or  quite  to  the  point  of  stopping. 
The  vessels  of  the  brain  and  spinal  cord,  being  with- 
in bony  walls,  where  the  direct  pressure  of  con- 
densed air  could  not  affect  them,  will  be  found  the 
most  distended  and  the  most  helpless  to  relieve 
themselves. 

A  tendency  to  fullness  of  habit  renders  work  in 
a  compressed  atmosphere  much  more  hazardous. 
Persons  of  this  build  have  more  fluids  in  the  body, 
the  distribution  of  which  is  changed  by  atmospheric 
pressure  in  the  manner  before  stated,  and  it  is  there- 
fore not  surprising  that  the  effect  upon  them  should 
be  greater  than  upon  lean  and  sinewy  persons,  whose 
bodies  contain  a  minimum  of  fluid. 

Starting  from  the  theory  already  given  as  to  the 
mode  in  which  the  disease  is  produced,  Dr.  Smith 


301 


was  led  to  the  idea  that  benefit  would  b^  derived 
from  the  use  of  an  agent  that  would  induce  contrac- 
tion of  the  capillaries,  and  thus  correct  the  want  of 
tone  which  was  considered  to  lie  at  the  foundation 
of  the  difficulty.  For  this  purpose  ergot  was  em- 
ployed. The  results  justified  the  theory.  Ergot 
was  certainly  very  useful  in  a  considerable  number 
of  cases,  a  fact  which  strengthens  the  behef  that 
these  symptoms  are  due,  at  least  in  part,  to  in- 
equality of  the  systemic  blood-circulation. 

In  persons  suffering  from  seasickness  the  special 
senses  and  the  power  of  imagination  become  greatly 
sharpened,  particularly  the  senses  of  hearing  and  of 
smell.  Not  only  the  odor  of  food  which  we  dislike, 
but  even  the  mere  fact  of  mentioning  such  food, 
causes  or  precipitates  the  outbreak  of  seasickness, 
and  to  listen  to  the  vomiting  of  others  is  still  more 
apt  to  cause  an  eruption.  A  person  inclined  to  sea- 
sickness may  be  compared  to  a  powder-room,  which 
requires  only  a  spark  to  cause  an  explosion. 

Another  occasion  of  seasickness  is  the  intense 
oscillation  of  the  vessel,  in  a  mechanical  way.  As 
vomiting  may  be  produced  by  a  blow  over  the 
stomach,  so  the  shaking  up  of  the  stomach  produced 
by  the  motion  of  the  vessel  may  also  cause  vomiting. 
Wherever  the  motion  of  the  vessel  is  most  violent 
and  irregular  seasickness  appears  in  the  most  aggra- 
vated and  cruel  form,  as,  for  instance,  in  the  Bay  of 


303 


Biscay,  the  Black  Sea,  the  Baltic  Sea,  and  the  great 
lakes  of  North  America,  where  direct  and  reflected 
waves  rush  from  different  directions.  So,  inasmuch 
as  the  largest  amount  of  motion  is  experienced  at 
the  extreme  ends  of  the  vessel,  it  is  there  we  find 
the  greater  number  of  victims. 

No  other  organ  of  the  body  is  subjected  to  such  a 
wide  range  of  reflected  nervous  disturbances  as  the 
stomach.  Persons  who  have  been  subject  to  ail- 
ments of  the  digestive  organs  on  land  will  be  much 
more  liable  than  others  to  suffer  severely  when  at 
sea.  Morbid  sympathetic  impressions  are  trans- 
mitted to  the  stomach  mainly  through  branches  of 
the  vasomotor  nerves  from  the  semilunar  ganglia  of 
the  abdomen,  and  through  the  pneumogastric  nerve. 
Through  this  mechanism  it  happens  that  a  pregnant 
uterus  not  unfrequently  produces  very  troublesome 
vomiting  while  upon  land,  and  that  many  women 
suffer  during  each  menstrual  period  from  nausea 
and  indigestion.  These  troubles  are  apt  to  be  greatly 
aggravated  by  their  occurrence  at  sea.  Such  women 
should  only  commence  a  voyage  after  the  menstrual 
period. 

Congestions  of  all  sorts  should  be  guarded 
against,  as  they  promote  seasickness.  Patients 
suffering  from  congestion  of  the  liver  are  usually 
seasick  during  the  whole  time  at  sea,  and  the  same 
is  the  case  in  the  congestion  due  to  pregnancy.    In 


303 


pregnant  women  the  spasms  of  the  stomach  are 
generally  transferred  to  the  uterus,  and  in  most 
cases  produce  very  satisfactory  labor.  An  abortion 
may  also  be  the  result  of  such  spasms.  When  the 
confinement  has  taken  place,  or  menstruation  ceases, 
seasickness  generally  disappears  at  once. 

Since  men  and  children  are  not  so  subject  to  con- 
gestions as  women,  they  are  less  often  attacked  by 
seasickness,  and  when  they  do  suffer,  the  attack  is 
often  less  violent.  Some  people  are  much  more 
liable  to  seasickness  than  others  ;  and,  in  fact,  some 
seafaring  men  are  seasick  on  every  voyage.  After 
living  ashore  for  some  time  seamen  are  apt  to  be 
slightly  seasick  on  going  to  sea  again,  and  if  the 
residence  on  land  has  lasted  for  several  years,  the 
attack  will  be  much  more  severe.  Many  seamen, 
however,  are  never  seasick,  and  cannot  appreciate 
the  sensation. 

The  stomach  cannot  be  expected  to  bear  too 
much,  and  therefore  only  the  most  digestible  ar- 
ticles of  food  should  be  eaten  at  sea,  and  these  not 
in  too  large  quantities.  After  eating  it  is  best  to 
assume  a  recumbent  position  with  the  head  elevated, 
either  on  deck  or  in  the  vestibule,  where  the  air  is 
pure  and  strong  winds  may  be  avoided.  As  long  as 
a  person  feels  well  he  should  take  plenty  of  exercise 
on  the  open  deck.  The  bowels  should  be  kept  in 
good  condition  in  order  to  promote  proper  circulation 


304 


of  the  blood,  and  to  avoid  congestions.  When  any- 
one is  attacked  by  seasickness,  he  should  observe 
the  recumbent  position,  as  above  mentioned,  taking 
special  care  to  rest  the  head,  as  otherwise  he  will 
experience  a  disagreeable  feeling  of  heaviness  and  a 
painful  sensitiveness.  The  stomach  should  not  be 
left  entirely  empty,  but  a  moderate  amount  of  food 
should  be  partaken  of,  as,  although  it  may  be  reject- 
ed by  the  stomach,  the  spasms  will  be  much  less 
painful  than  when  that  organ  is  empty.  Very  sim- 
ple foods  are  best,  especially  those  of  a  sourish  or 
sweet-sourish  flavor,  including  fruits,  especially 
grapes,  grapejuice,  fruit  preserves,  sourish  soups, 
soft-boiled  eggs,  sauerkraut  (better  perhaps  raw  than 
cooked),  and  fine  unadulterated  dessert-wines  in 
small  quantity.  On  the  other  hand,  other  wines,  as 
well  as  spirits  and  very  sour  and  sharp  foods,  do  not 
agree  with  the  stomach.  Gradually  the  convales- 
cing patient  may  enrich  his  menu  hy  the  addition  of 
pickled  herrings,  sardines,  caviar,  olives,  cheese, 
and  finally  he  will  take  his  place  at  the  common 
table  without  fear  of  impolite  revelations. 

No  medicine  so  far  tried  has  been  found  reliable. 
The  best  service  has  been  rendered  by  the  arsenical 
mineral  waters,  one  or  two  glasses  being  drank  dur- 
ing the  day.  When  these  are  not  obtainable,  a  few 
drops  of  Fowler's  solution  in  a  glass  of  water  may 
be  substituted.     At  times  antipyrin,  cerium,  chloro- 


305 


form,  ether,  or  siilfonal  may  be  found  of  use.  The 
author  cannot  refrain  from  giving  his  readers  the 
benefit  of  the  advice  of  several  trustworthy  ship's 
officers,  who  state  that  the  administration  of  ten  to 
twenty  drops  of  kerosene  oil  on  a  lump  of  sugar, 
followed  half  an  hour  later  by  a  cup  of  hot  tea,  will 
cure  the  most  obstinate  case  of  seasickness.  The 
author  is  inclined  to  accept  this  prescription  with 
some  hesitation,  as  he  is  aware  that  ship's  officers 
are  often  inveterate  jokers.  On  the  other  hand,  it 
must  be  admitted  that  the  same  statement  has  been 
made  by  the  officers  of  different  ships. 


ASIATIC  CHOLERA. 

Asiatic  cholera  is  signalized  by  profuse  and  fre- 
quent watery  discharges  from  the  bowel.  The  attack 
is  ushered  in  with  symptoms  more  or  less  like  ordi- 
nary diarrhoea.  These  soon  become  more  urgent,  and 
in  a  short  time  follow  cramps  and  profuse  evacua- 
te 3ns  of  *'  rice  water  "  liquid.  The  entire  watery  por- 
tion of  the  blood  seems  to  be  rapidly  passing  off  in 
this  form,  leaving  the  blood  viscid,  darker  in  color, 
and  lessened  in  quantity.  The  altered  circulating 
fluid  gives  to  the  skin,  particularly  to  that  of  the 
face,  quite  a  dark  color,  and,  naturally  enough 
under  the  circumstances,  also  a  shriveled  look.    As 


306 


is  to  be  expected,  the  skin  and  the  entire  body  more- 
over seem  quite  cold. 

The  appropriate  treatment  of  cholera  is  similar  to 
that  to  be  employed  in  cases  of  dysentery,  but  in- 
cludes in  addition  the  administration  of  large  quanti- 
ties of  hot  fluids,  especially  of  hot  lemonade,  for  the 
purpose  of  keeping  the  blood  thin.  To  these  fluids 
may  be  added  liberally  rum,  brandy,  whiskey,  and 
hot  red  wine.  That  no  time  may  be  lost  in  trying 
to  arrest  the  evident  tendency  of  the  blood  to  seek 
the  bowel,  applications  of  heat  must  be  employed  in 
various  forms  with  the  object  of  diverting  the  circu- 
lation outward.  Hot  flannels,  vessels  of  hot  water, 
and  stimulating  applications  may  be  diligently  used 
upon  the  body  and  limbs,  and  friction  applied  by 
moving  one's  hands  from  the  patient's  extremities 
to  his  heart.  It  seems  not  impossible,  farthermore, 
that  fruits  deprived  of  their  skin  and  seeds,  as  well 
as  other  acid  articles  of  food,  especially  lemons,  may 
be  found  of  great  advantage  in  these  cases,  since  the 
cholera  bacillus  is  supposed  to  be  active  only  in  alka- 
line solutions. 

Cholera  is  not  nearly  so  fatal  a  disease  as  is  gen- 
erally believed.  Many  die  of  cholera,  it  is  true,  but 
because  so  many  are  attacked.  It  is  well  established 
now  that  the  cholera  germ  is  inimical  only  to  certain 
persons  whose  stomachs  are  weak.  It  threatens 
danger,     moreover,     only    when    it    flourishes    in 


soy 

the  intestines.  In  a  healthy  stomach  the  germ  will 
be  destroyed  by  the  digestive  juices,  so  as  not  to  pass 
to  the  intestine  at  all.  As  long  as  life  remains  'uhere 
is  hope  in  this  affection,  and  people  who  were  ^jiven 
up  as  dead  have  been  known  to  rally  and  finally  sur- 
vive. In  the  fall  cases  of  cholera  not  infrequently 
assume  gradually  a  typhoid  character,  and  the  dis- 
ease mostly  disappears  upon  the  accession  of  cold 
weather. 

Cholera  may  be  avoided  by  avoiding  mental  de- 
pression, want  of  cleanliness,  dampness,  over-crowd- 
ing, and  bad  water,  for  these  influences  both  invite 
the  malady  and  increase  its  fatality.  The  cholera 
bacillus  is  best  propagated  in  a  moist  atmosphere  and 
in  damp  spots  and  damp  clothing.  Water  of  surface 
origin,  never  mind  how  far  down  the  bottom  of  the 
well,  or  how  unlikely  to  be  contaminated  by  sewer 
gas  and  kindred  emanations,  should  be  carefully 
avoided  when  cholera  prevails.  Ordinary  water  may 
be  boiled  under  cover  for  a  few  moments,  to  destroy 
the  animal  and  vegetable  life  it  contains.  ^Filtering 
water  does  not  necessarily  purify  it,  but  merely 
strains  out  particles  too  large  to  pass.  What  is 
left  often  constitutes  the  dangerous  element.  Heat 
destroys  that. 

Nothing  likely  to  invite  or  force  the  blood  to  the 
mucous  membrane  may  be  permitted.  Hence  all  in- 
digestible articles  and  those  difficult  of   digestion 


308 

must  be  eschewed.  Warm  food  is  to  be  preferred. 
Meals  after  fatigue,  unless  of  easy  digestion,  must 
not  be  indulged  in,  and  especial  heed  should  be  paid 
to  the  late  meal  of  the  day,  when  there  is  always  less 
strength  than  earlier. 

During  an  epidemic  all  intestinal  affections  assume 
the  general  features  of  the  prominent  disease,  and  it 
is  noticed  that  when  cholera  prevails  the  most  tri- 
fling irregularity  in  a  greater  or  less  degree  assumes 
the  well  known  symptoms  of  that  disorder. 


DYSENTERY. 

Dysentery  is  properly  a  disease  of  hot  countries, 
where  it  often  occurs  as  an  epidemic  ;  but  it  is  also 
encountered  at  times  in  more  temperate  climates. 
Sleeping  in  crowded  dormitories,  catching  cold,  get- 
ting wet,  and  errors  in  diet,  are  some  of  the  causes 
which  lead  to  the  outbreak  of  this  disease.  Dysen- 
tery is  a  diphtheritic  affection  of  the  mucous  mem- 
brane of  the  lower  bowel,  which  takes  at  first  a  mild 
form,  but  which  may  quickly  pass  to  a  more  serious 
condition.  Its  first  appearance  is  marked  by  col- 
icky pains  with  frequent  and  severe  tenesmus  and 
bloody  diarrhoea.  These  may  be  followed  by  violent 
fever,  coldness  of  the  extremities,  swelling  of  the 
abdomen,  great  debility,  unconsciousness.  Although 


309 


dysentery  is  probably  no  more  communicable  from 
one  person  to  another  than  cholera,  still  it  seems 
very  apparent  that  it  may  be  conveyed  from  the  sick 
to  the  well  through  the  medium  of  excrements, 
chamber-vessels,  or  syringes.  It  is  therefore  best, 
because  safest,  to  avoid  using  these  articles  after 
they  have  been  used  by  a  sick  person  ;  and  it  is  also 
necessary  to  thoroughly  disinfect  the  evacuations, 
and  not  throw  them  into  the  common  closet.  Dur- 
ing the  prevalence  of  an  epidemic  of  dysentery  all 
food  and  drink  should  be  avoided  which  is  likely  to 
produce  diarrhoea  :  on  the  other  hand,  food  which  is 
apt  to  produce  constipation  should  just  as  carefully 
be  refrained  from,  for  this  is  equally  likely  to  cause 
irritation  and  consequent  diarrhoea.  Catarrh  of  the 
stomach  and  intestines  should  be  prevented  as  far 
as  possible,  and  when  it  occurs  should  be  promptly 
treated,  for  catarrhal  mucous  membranes  are  not- 
ably favorable  to  the  reception  of  the  dysenteric 
poison. 

The  treatment,  not  to  speak  of  the  use  of  drugs, 
should  consist  in  the  constant  use  of  warm  apphca- 
tions  to  the  abdomen  and  the  administration  of 
enemata  of  warm  demulcent  substances,  such  as 
starch.  The  abdomen  and  feet  must  be  kept  warm. 
The  bed  should  be  firm  and  supplied  with  the  neces- 
sary protectors  :  an  extra  bed  is  very  desirable  : 
a  water-cushion  is   also   to  be  recommended.     In 


310 


order  to  replace  the  blood  constituents  which  pass 
away  with  the  evacuations,  a  sufficient  quantity  of 
warm,  easily-digested  food  is  required,  in  order  that 
it  may  be  absorbed  by  the  stomach  and  upper  intes- 
tine without  irritating  by  its  presence  the  diseased 
lower  bowel.  Such  food  is  warm  rice-water,  warm 
barley-water,  or  beef -tea  with  an  egg  beaten  in  it. 
An  excellent  article  of  food  may  be  prepared  by  en- 
closing a  pint  of  ordinary  wheat  flour  in  a  muslin 
bag  and  boiling  it  in  water  for  ten  or  twelve  hours  : 
the  external  crust  then  being  removed,  the  inner 
portion,  which  will  be  found  to  have  undergone  just 
the  proper  change,  is  to  be  mixed  with  hot  milk  to  a 
gruel  and  cinnamon  added.  For  some  time  after 
recovery  only  liquid  food  should  be  allowed  the 
patient,  and  the  abdomen  should  be  protected  by 
wearing  flannel. 


SUMMER  COMPLAINT. 

Summer  complaint  is  the  name  often  given  to  an 
inflammation  of  the  stomach  and  intestines,  by 
which  a  large  number  of  children  are  annually  car- 
ried off,  especially  of  those  who  are  in  their  second 
summer.  The  great  mortality  of  the  disease  is  due 
partly  to  the  disturbed  condition  of  the  digestive 
organs,  which  renders  it  impossible  for  them  to  sup- 


311 


ply  the  necessary  amount  of  reconstructive  material 
to  the  blood,  partly  also  to  the  withdrawal  from  the 
blood,  by  reason  of  the  diarrhoea,  of  a  large  amount 
of  nutritive  material.  Sometimes  the  inflammation 
is  confined  to  the  intestines,  and  the  disease  is  char- 
acterized by  diarrhoea  alone ;  in  other  cases  the 
stomach  only  is  affected,  and  then  loss  of  appetite 
and  vomiting  are  the  result. 

The  closest  attention  in  these  cases  must  naturally 
be  paid  to  correct  nutrition.  As  a  rule  the  first 
symptom  of  illness  is  the  diarrhoea,  which  becomes 
rapidly  more  severe  and  the  discharges  more  watery 
and  colorless,  while  later  on  the  complication  of 
vomiting  is  added. 

Warm  flannels  and  other  warm  applications  to 
the  abdomen  do  excellent  service  in  restraining  the 
diarrhoea.  From  the  appearance  of  the  earliest 
symptom  two  or  three  teaspoonfuls  of  lime-water 
should  be  given  every  day  in  milk  or  beef -tea,  and  a 
small  pinch  of  bismuth  and  magnesia  after  every 
meal.  On  account  of  the  rapid  progress  made  by 
this  disease  it  is  best  to  consult  a  physician  upon  the 
first  appearance  of  bowel  disorder. 

*^  The  fact  is  universally  admitted,  that  the  sum- 
mer season,  stated  in  a  general  way,  is  the  cause  of 
this  diarrhoeal  epidemic.  That  atmospheric  heat 
does  not  in  itself  cause  the  diarrhoea  is  evident  from 
the  fact  that,  in  the  rural  districts  there  is  the  same 


312 


intensity  of  heat  as  in  the  cities,  and  yet  the  summer 
complaint  does  not  occur.  Observations  show  that 
the  noxious  effluvia  with  which  the  air  becomes  pol- 
luted under  such  circumstances  constitute  or  contain 
the  morbific  agent." 

An  exception  to  this  view  of  Dr.  J.  Lewis  Smith 
is,  however,  to  be  made  in  regard  to  the  direct  sun- 
beams striking  the  child's  unprotected  head. 

In  this  group  are  also  wrongly  classed  those  sud- 
den and  violent  attacks  in  children,  which  in  adults 
are  known  as  Sunstroke  or  Overheating,  and  in 
which  we  find  considerable  disturbances  of  the  brain, 
and  also,  by  reflex  action,  disturbances  of  other 
organs,  especially  the  abdominal  and  respiratory 
organs,  besides  faintness,  depression,  and  loss  of 
consciousness. 

Mothers  and  nurses  who  accompany  children  upon 
day  summer  excursions,  such  as  the  trip  by  water 
from  New  York  to  Coney  Island,  should  avoid  ex- 
posing their  charges  to  the  sun's  rays  at  midday.  In 
heated  weather  it  is  best  not  to  encourage  the  child 
to  play  in  the  surf,  but  rather  to  take  it  to  a  shady, 
breezy  spot  upon  the  pier,  if  one  exists,  and  as  far 
out  toward  the  sea  as  possible. 

The  little  patient  who  is  affected  by  the  heat  should 
be  placed  in  a  cool  situation,  where  uninterrupted 
ventilation  may  be  had,  and  warm  applications  made 
to  his  abdomen,  while  ice  or  cold  in  somB  other  form 


313 


is  applied  to  the  head.  A  teaspoonful  of  milk  punch 
containing  red  pepper  may  be  given  every  half  hour. 
The  most  important  measure,  however,  is  to  allow 
the  patient  to  inhale  from  five  to  ten  drops  of  chloro- 
form sprinkled  upon  a  handkerchief  every  five  min- 
utes until  the  symptoms  are  materially  relieved. 

Summer  complaint  is  caused  by  overfeeding  or  by 
heat  and  bad  air,  never  by  teething.  Dr.  Eipley,  of 
the  New  York  Polyclinic,  says:  ^^ Young  turkeys 
and  chickens  sujffer  with  the  same  symptoms  during 
the  summer,  and  are  successfully  treated  by  keeping 
them  in  a  cooler  atmosphere  and  looking  carefully 
after  their  diet.  As  these  fowls  do  not  cut  teeth,  we 
may  safely  assert  that  teething  cannot  be  held  ac- 
countable for  their  ^troubles.'"  Jacobi  directs  to 
*^keep  the  door  and  windows  open,  and  to  wash  the 
child  with  cold  water  at  least  twice  a  day,  and  oftener 
in  very  hot  weather.  If  the  child  vomits  and  has 
diarrhoea,  it  should  receive  nothing  to  eat  for  four  or 
six  hours,  but  as  much  fresh  air  as  possible.  At  the 
outset  a  few  drops  of  whiskey  or  cognac  may  be 
given  in  a  teaspoonful  of  ice-water  every  ten  minutes, 
but  not  more  until  the  doctor  comes.  As  long  as 
vomiting  and  diarrhoea  persist  neither  should  milk 
be  given,  nor  opium  nor  any  other  sedative,  nor  tea." 

Dr.  Smith  continues,  '^  Every  physician  knows 
that  the  mode  of  feeding  has  much  to  do  with  the 
occurrence  of  summer  complaint.    A  large  proper- 


314 


tion  of  those  who  each  summer  fall  victims  to  it 
would  doubtless  escape,  if  the  feeding  were  exactly 
proper.  The  younger  the  infant,  the  less  able  is  it 
to  digest  any  other  food  than  breast-milk,  and  the 
more  liable  is  it  therefore  to  suffer  from  diarrhoea,  if 
bottle-fed.  Feeding  an  infant  in  the  hot  months  with 
indigestible  and  improper  food,  as  fruits  with  seeds, 
or  the  ordinary  table-food  prepared  in  such  a  way 
that  it  overtaxes  the  digestive  function  of  the  infant,, 
causes  diarrhoea  and  not  infrequently  cholera  infan- 
tum. Many  obstinate  cases  of  summer  complaint 
begin  to  improve  under  change  of  diet,  as  by  the 
substitution  of  one  kind  of  milk  for  another,  or  the 
return  of  the  infant  to  the  breast  after  it  has  been 
temporarily  withdrawn  from  it. 

"Milk  from  cows  stabled  in  the  city  or  having  a 
limited  pasturage  near  the  city,  and  fed  upon  a  mix- 
ture of  hay  with  garden  and  distillery  products,  the 
latter  often  largely  predominating,  is  unsuitable.  It 
is  deficient  in  nutritive  properties,  prone  to  fermenta- 
tion, and  from  microscopical  and  chemical  examina- 
tions which  have  been  maae  it  appears  that  it  often 
contains  deleterious  ingredients.  If  milk  be  obtained 
from  distant  farms,  where  pasturage  is  fresh  and 
abundant — and  in  the  large  cities  that  is  the  usual 
source  of  the  supply — considerable  time  elapses  be- 
fore it  is  served  to  customers,  so  that,  particularly  in 
the  hot  months  of  July  and  August,  it  frequently  has 


315 

begun  to  undergo  lactic-acid  fermentation  when  the 
infants  receive  it.  That  dispensed  to  families  in  the 
morning  is  the  milking  of  the  previous  morning  and 
evening. 

"Cholera  Infantum  is  the  most  severe  form  of 
summer  complaint.  It  receives  the  name  which  des- 
ignates it  from  the  violence  of  its  symptoms,  which 
closely  resemble  those  of  Asiatic  cholera.  It  is,  how- 
ever, quite  distinct  from  that  disease.  It  is  charac- 
terized by  frequent  stools,  vomiting,  great  elevation 
of  temperature,  and  rapid  and  great  emaciation  and 
loss  of  strength. 

''Weauing  just  before  or  in  the  hot  weather 
should,  if  possible,  be  avoided,  and  removal  to  the 
country  should  be  recommended,  especially  for  those 
who  are  deprived  of  the  breast-milk  during  the  age 
when  such  nutriment  is  required. 

''It  is  also  very  important  that  the  infant  receive 
its  food  in  proper  quantity  and  at  proper  intervals,  for, 
if  the  mother  or  nurse,  in  her  anxiety  to  have  it 
thrive,  feed  it  too  often  or  in  too  large  quantity,  the 
surplus  food  which  it  cannot  digest,  if  not  vomited, 
undergoes  fermentation,  and  consequently  becomes 
irritating  to  the  gastro-intestinal  surface.  All  phy- 
sicians of  experience  agree  in  the  propriety  of  send- 
ing infants  affected  with  simimer  diarrhoea  from 
large  cities  to  localities  in  the  country,  which  are 
free  from  malaria  and  sparsely  inhabited,  in  order 


316 

that  they  may  obtain  the  benefits  of  a  purer  air. 
Many  are  the  instances  each  summer  of  infants  re- 
moved to  the  country  with  intestinal  inflammation, 
with  features  haggard  and  shrunken,  with  limbs 
shriveled  and  skin  lying  in  folds,  too  weak  to  raise, 
vomiting  nearly  all  the  nutriment  taken — presenting 
indeed  an  appearance  seldom  observed  in  any  other 
disease,  except  in  the  last  stages  of  phthisis — and  re- 
turning in  late  autumn  with  the  cheerfulness,  vigor, 
and  rotundity  of  health." 


CONSTIPATION. 

Constipation,  according  to  Dr.  W.  W.  Johnston, 
of  Washington,  "  occurs  most  frequently  in  ad- 
vanced life.  It  is  the  effect  of  loss  of  peristaltic 
force  and  of  diminution  of  sensibility  in  the  lower 
bowel,  and  is  associated  with  general  functional  in- 
activity and  with  muscular  degeneration  and  obesity. 

"  Women  are  prone  to  constipation  much  more 
than  men.  False  modesty,  which  imposes  restraint 
upon  young  girls,  and  their  ignorance  of  the  neces- 
sity of  regularity,  their  habits  of  indoor  life,  and 
avoidance  of  exercise,  are  largely  the  causes  of  this. 
Chlorosis  and  anaemia  in  girls  are  almost  invariably 
associated  with  constipation. 


317 

*'  Persons  of  sedentary  pursuits  or  who  work  in 
constrained  attitudes — lawyers,  clerks,  tailors,  shoe- 
makers, and  seamstresses — are  predisposed  to  con- 
stipation. 

''Resisting  the  desire  to  empty  the  bowel  inter-, 
rupts  the  necessary  reflex  acts,  and  finally  the  mus- 
cular excitability  and  response  to  the  presence  of 
feces  are  entirely  wanting.  The  continued  contact 
of  fecal  matter  with  the  mucous  membrane  wears 
out  its  susceptibility ;  the  over-distension  of  the  rec- 
tum enfeebles  the  power  of  its  muscular  wall.  The 
use  of  aperients  is  an  important  agent  in  developing 
the  constipated  habit  by  over-stimulating  and  wear- 
ing out  muscular  activity.  The  idea  that  a  daily 
movement  is  a  necessity,  and  that  an  occasional  pur- 
gative is  useful  in  relieving  the  system  of  morbid 
matter  which  would  otherwise  induce  disease,  is  the 
chief  source  of  this  hurtful  custom.  The  traditional 
meaning  attached  to  the  term  Biliousness  implied 
the  resort  to  cathartics  for  its  relief.  If  the  term 
'bilious,'  as  applied  to  diseases,  were  abandoned,- 
much  good  would  come  of  it.  The  general  use  of 
purgative  mineral  waters  has  added  to  this  evil.  At  - 
first  the  injurious  effects  are  not  apparent,  but  in 
time  the  reflex  function  is  not  brought  into  activity 
except  by  artificial  aids.  The  intestinal  and  rectal 
muscles  must  be  whipped  into  action,  their  normal 
contractile  power  being  lost. 


318 


"  Chronic  and  serious  diseases,  by  enfeebling  the 
muscular  movements  which  take  part  in  defecation, 
as  well  as  by  the  general  feebleness  and  the  chronic 
intestinal  catarrh  and  indigestion  which  they  create, 
are  causes  of  constipation.  Constipation  accom- 
panies obesity,  for  in  very  fat  persons  the  abdomi- 
nal walls  have  but  little  power  of  contraction  ;  the 
muscle-layer  is  thin  and  flaccid.  The  muscle  of  the 
bowel  is  in  a  state  of  fatty  degeneration,  and  atony 
and  dilatation  of  the  gut  follow. 

"Loss  of  fluids  by  abundant  perspiration,  by  di- 
uresis, diabetes,  and  lactation,  increases  the  dryness 
of  the  bowel  contents  and  hinders  free  evacuation. 
This  is  observed  as  the  result  of  the  arrival  in  a 
tropical  climate,  and  in  very  hot  weather  in  any 
climate. 

"  An  indigestible  diet  in  excess,  especially  vege- 
table food,  a  large  part  of  which  is  insoluble,  consti- 
pates by  filling  the  bowel  with  matter  which  cannot 
be  got  rid  of,  and  chronic  catarrh  results.  The 
stones  and  seeds  of  fruits,  as  cherry  and  plum 
stones,  raspberry  and  currant  seeds,  husks,  corn, 
and  oats,  produce  acute  or  chronic  constipation  with 
symptoms.  Magnesia,  insoluble  pills,  and  other 
medicines  sometimes  form  concretions  in  the  bowel. 
Accidental  concretions  form  in  the  intestinal  canal 
and  are  sources  of  obstruction.  Any  foreign  body  is 
a  nucleus,  around  which  concentric  layers  of  phos- 


319 


phate  of  lime  are  deposited,  and  thus  a  hard  calculus 
is  formed.  Gallstones  may  pass  into  the  canal  and 
there  accumulate  in  such  numbers  as  to  interfere 
with  the  passage  of  the  fecal  matter." 

Long  continued  sluggishness  of  defecation  may 
interfere  with  digestion,  and  consequently  also  with 
the  formation  of  the  blood  and  the  nutrition  of  the 
body ;  farthermore  it  may  lead  to  disturbances  of 
the  portal  circulation,  to  hemorrhoids,  and  to  mental 
disturbances  even.  And  yet  help  lies  so  near.  The 
remedy  may  be  found  in  the  use  of  fruits,  or  of  pre- 
served rhubarb,  or  of  prunes  boiled  with  senna-leaves, 
or  of  decoction  of  tamarinds,  or  of  eggs  fried  in  cas- 
tor-oil, or  of  castor-oil  mingled  with  lemon-juice  to 
improve  its  taste  and  effect,  or  of  the  fresh  skin  of 
an  orange  thoroughly  masticated,  or  in  the  drinking 
of  warm  water  or  of  Hungarian  bitter-water. 

"When  it  is  desirable  to  empty  the  bowel  in 
acute  constipation  a  warm  water  enema  for  adults 
and  children  is  the  best  means.  The  kneading  of  the 
muscles  over  the  abdomen  can  be  combined  advan- 
tageously with  an  effort  to  accelerate  the  passage  of 
the  intestinal  contents  by  manipulation  in  tb©  direc- 
tion of  the  movement.  Drugs  should  be  thought  of 
last,  not  first.  Infants  and  children  especially  should 
be  cured  of  constipation  without  purgatives,  if  pos- 
sible." 

If  the  constipation  returns  easily,  the  abdomen 


320 


should  be  kneaded,  rubbed,  pressed,  and  otherwise 
manipulated,  gymnastics  and  baths  should  be  re- 
sorted to,  and  exercise  should  be  taken  frequently. 
One  of  the  most  reliable  measures  always  is  the  ad- 
ministration of  an  enema  of  water  alone,  or  of  water 
with  soap,  salts,  or  oil. 

When  Abdominal  Pains  occur,  especially  if  se- 
vere and  attended  by  constipation,  the  possibility  of 
a  hernia  must  be  remembered  and  a  physician  sum- 
moned at  once.  If  vomiting  is  added,  poisoning 
may  be  suspected.  If  the  abdomen  is  swollen  and 
the  pain  is  increased  by  pressure,  probably  the  peri- 
toneum is  in  a  state  of  inflammation,  and  the  patient 
should  be  put  to  bed  and  warm  fomentations  con- 
tinually applied — a  treatment  which  proves  of  equal 
service  when  violent  abdominal  pains  occur  before 
or  during  menstruation.  Rumbling,  colicky  pains, 
accompanied  by  diarrhoea  or  constipation,  demand 
warm,  demulcent  enemata,  warm  applications  to  the 
abdomen,  and  carminative  remedies,  such  as  cara- 
way-seed, aniseed,  or  fennel  tea.  If  relief  does  not 
come  quickly,  a  physician  should  be  called  at  once, 
since  internal  strangulation  or  some  other  grave  dis- 
ease of  the  intestine  may  be  found  to  exist. 

Flatulence  is  occasioned  by  the  gases  generated 
in  the  stomach  and  intestinal  canal.  These  gases 
are  not  abnormal,  unless  it  be  in  quantity.  They 
serve  the  purpose  of  forming  an  elastic  air-cushion 


321 


within  the  abdominal  cavity,  and  this-,  when  com- 
pressed by  the  diaphragm  and  abdominal  muscles, 
assists  the  established  function  of  those  muscles. 
Remedies  for  expelling  the  wind,  for  stimulating  the 
intestinal  movements,  and  for  impeding  decomposi- 
tion may  be  found  among  the  ethereal  oily  herbs, 
such  as  chamomile,  fennel,  anise,  caraway,  pepper, 
mint,  calamus,  valerian,  and  ginger,  which  should 
be  given  in  warm  decoctions  or  infusions.  The 
gases  may  also  be  withdrawn  by  means  of  a  rectal 
syringe  having  a  long  thin  nozzle.  The  formation 
of  intestinal  gases  may  be  prevented  by  restricting 
one's  self  to  a  suitable  diet  of  light  articles,  in  which 
the  quantity  of  vegetable  food,  of  fats,  and  of 
starchy  and  sweet  substances  is  limited,  and  in 
which  no  husks  are  found.  The  abdominal  muscles 
should  be  exercised  by  active  movements  and  by 
massage,  and  care  should  be  taken  that  the  bowels 
move  regularly. 


HEMORRHOIDS. 

Hemorrhoids  are  engorgements  of  the  veins  of 
the  rectum,  due  to  arrested  or  impeded  returning 
circulation,  in  like  manner  as  in  varicose  veins  of  the 
leg.  The  most  common  cause  is  the  so-called  stag- 
nation of  the  portal  vein,  to  which  reference  has  been 


322 


made  in  speaking  of  constipation.  But  retarded 
circulation  may  also  be  occasioned  by  chronic  affec- 
tions of  the  rectum,  abdomen,  liver,  heart,  and  lungs. 
On  this  account  it  is  useless  to  speak  of  special  treat- 
ment (otherwise  than  surgical),  because  the  root  of 
the  evil  must  first  be  cured ;  although  local  distress 
may  be  relieved  by  frequent  bathing,  by  the  ap- 
plication of  cold  water,  and  by  the  use  of  fresh  tallow 
or  salve.  These  annoyances  may  be  avoided  or  at 
least  diminished  by  keeping  up  a  brisk  circulation  in 
the  portal  system.  In  order  to  accomplish  this  latter 
end  the  sufferer  should  take  much  exercise,  especially 
in  the  open  air,  should  eat  and  drink  moderately  and 
simply,  should  drink  water  copiously,  should  take 
care  not  to  constrict  his  abdomen  by  unsuitable 
clothing  or  by  leaning  forward  when  seated,  and 
should  avoid  intellectual  and  emotional  excesses,  for 
these,  by  weakening  the  general  system,  enfeeble 
the  rectal  veins  and  favor  their  engorgement.  The 
ideal  life  may  be  best  attained  in  summer,  when  all 
nature  is  at  her  brightest  and  gayest,  and  when 
serious  employments  may  be  left  behind  for  a  Bohe- 
mian existence  in  nature's  wilds.  When  one's  means 
do  not  permit  this,  he  should  perform  suitable  bodily 
work  at  home,  should  drink  plenty  of  water,  should 
bathe  regularly,  and  should  keep  his  bowels  open 
with  injections  of  warm  water.  Great  caution  must 
be  observed  about  using  strong  purgatives,  for  these 


3^3 


are  sure  to  do  permanent  injury  to  the  stomach  and 
intestines. 

' '  The  food  must  be  moderate,  unirritating,  leaving 
but  Httle  fecal  refuse,  and  its  composition  must  as  far 
as  possible  be  of  such  a  nature  as  to  favor  secretion 
and  the  peristaltic  movement  of  the  intestines,  such 
as  fruits  and  certain  vegetables.  Cold  washing, 
clysters,  and  sitz-baths  are  also  important  remedies 
to  keep  the  rectum  and  anus  free  and  clean,  and  to 
prevent  inflammation." 


DISEASES  OF  THE  URINARY  TRACT. 


Diseases  of  the  urinary  apparatus  are  always  to 
be  regarded  seriously.  They  may  affect  either  the 
urethra,  the  bladder,  the  ureters,  or  even  the  kidneys. 
The  diagnosis  of  these  diseases  requires  in  some  in- 
stances the  application  of  careful  chemical  and  micro- 
scopical tests ;  in  others  the  examination  must  be 
made  according  to  surgical  rules,  and  sometimes  by 
the  aid  o£  the  newly  invented  mirror  for  examining 
the  bladder  and  urethra.  Every  sufferer  from  such 
complaints  should  therefore  apply  at  the  earliest  op- 
portunity to  a  competent  physician. 

Spasm  of  the  Bladder  is  a  violent  contraction  of 
the  muscular  wall  of  the  bladder,  accompanied  by 
great  pain  and  by  strong  and  constant  desire  to 
urinate,  along  with  actual  inability  to  do  so.  The 
cause  is  in  most  cases  a  local  one — some  disease  of 
the  urinary  or  generative  apparatus,  stone  in  the 
bladder,  acid  urine.  Pending  the  arrival  of  the  doc- 
tor, treatment  should  be  given  by  the  prompt  applica- 
tion of  hot  poultices  or  hot  bathing  over  the  bladder, 
and  by  the  copious  drinking  of  warm  water  and  of 
thin  linseed  tea. 

324 


325 


Wetting  the  Bed  may  be  avoided  by  not  allowing 
a  child  so  troubled  to  drink  at  night.  This  may  be 
rendered  easier  by  also  refusing  food  at  night ;  but 
an  abundant  supply,  both  of  food  and  of  drink,  should 
be  given  some  hours  before  bedtime,  care  being  ex- 
ercised that  no  indigestible  articles  are  allowed.  The 
child  should  not  sleep  upon  a  bed  that  is  too  soft  and 
warm,  nor  should  it  lie  upon  its  back  ;  and  it  should 
be  waked  once  or  more  during  the  night  to  urinate. 


DISEASES  OF  THE  SKIN. 


All  unusual  eruptions  upon  the  skin  should  be 
seriously  regarded,  especially  if  they  are  symmetri- 
cal in  their  arrangement,  or  if  sores  appear  upon 
the  lower  abdominal  region.  Such  spots  are  often 
quite  painless,  and  therefore  their  dangerous  nature 
is  less  apt  to  be  recognized. 

Eczema  is  due  to  a  deficiency  in  the  secretion  of 
the  fat-glands  of  the  skin,  a  condition  which  fre- 
quently results  from  excessive  washing,  especially 
in  cold  water.  Manifestly  such  an  influence  acts 
much  more  readily  upon  a  tender  and  vulnerable 
skin,  but  the  eruption  may  develop  after  a  time 
even  upon  the  callous  skin  of  those  whose  occupations 
expose  them  to  much  contact  with  water,  notably 
upon  the  hands  of  washerwomen  and  bakers.  Relief 
and  protection  may  be  secured  by  the  application  of 
linseed  oil,  glycerine,  vaseline,  and  zinc  salve. 

Blisters  and  Chafing-sores  develop  upon  surfaces 
which  are  continually  brought  into  contact  with  one 
another  in  walking,#or  which  are  otherwise  irritated 
by  friction.  The  perspiration  assists  materially  in 
their  production.     Powdered  gum  and  rice-powder 

33Q 


327 


are  effective  in  healing  them,  but  still  more  so  is 
linseed  oil,  zinc  salve,  or  powdered  tannin. 

Corns  and  Frostbites  may  be  cured  by  applying  a 
solution  of  equal  parts  of  collodium,  tincture  of 
iodine,  and  castor-oil,  or  of  the  first  two  alone,  or  one 
of  acetic  acid.  During  the  summer  following  the 
occurrence  of  a  frostbite  an  effort  should  be  made  to 
contract  the  dilated  bloodvessels  of  the  affected  re- 
gion by  painting  it  with  furniture  glue  or  with  col- 
lodium. Corns  may  be  prevented  by  avoiding  shoes 
either  too  tight  or  too  large,  and  by  applying  over 
any  suspicious  spot  French  adhesive  plaster  or  the 
ordinary  lead  plaster,  which  must  adhere  closely 
and  readily.  Dark  colored  plasters  are  harmful  on 
accout  of  the  rubber  they  contain. 

For  the  annoying  symptoms  of  Chilblain  and  of 
a  similar  condition  which  often  extends  into  ulcera- 
tion and  sloughing,  the  most  serviceable  measures 
are  to  keep  away  from  the  fire,  and,  every  night 
before  retiring,  to  bathe  the  feet  in  cold  water  or  to 
rub  them  with  snow. 

The  disagreeable  odor  which  sometimes  arises 
irom  Perspiring  Feet  may  be  dispelled  by  sprink- 
ling salicylic  acid,  tartaric  acid,  or  tannin  into  the 
stockings.  When  a  similar  annoyance  affects  the 
axilla,  an  axillary  pad  should  be  worn,  sprinkled 
with  alum,  tannin,  or  salicylic  acid,  or  dipped  in  a 
solution  of  tartaric  acid  and  then  dried. 


PARASITES. 


Protection  against  Scabies  may  be  secured  by 
avoiding  dirty  beds  when  traveling,  by  refusing  to 
sleep  with  strangers,  and  by  shunning  contact  with 
old  clothes,  or,  if  these  precautions  prove  impossible, 
by  washing  one's  self  with  strongly  smelling  lini- 
ments, like  camphor  and  spirits  of  turpentine,  and 
with  pungent  soaps,  such  as  that  made  from  potash. 
The  clothing  of  a  patient  troubled  with  scabies 
should  be  subjected  to  the  dry  heat  of  an  oven, 
rubbed  with  spirits  of  turpentine  or  kerosene  oil, 
and  thoroughly  washed  with  lye  or  soda. 

The  best  applications  to  surfaces  affected  with 
scabies  are  spirits  of  turpentine,  sulphur  ointment, 
and  balsam  of  Peru.  Another  substance  worth  recom- 
mending is  kerosene  oil,  which  renders  good  service 
also  against  fleas,  lice,  bedbugs,  and  other  species 
of  vermin,  but  care  must  be  taken,  on  account  of  its 
irritating  properties,  not  to  leave  it  longer  in  contact 
with  the  skin  than  about  a  quarter  of  an  hour. 

The  Echinococcus  is  a  parasite  found  not  infre- 
quently within  the  bodies  of  dogs,  and  conveyed 
from  them  to  man,  especially  when  the  dog  is 
allowed  to  lick  its  master.  These  organisms  develop 
within  the  alimentary  canal,  and  particularly  within 
the  liver,  less  often  in  the  kidneys.     The  gradual 

338 


329 


destruction  of  the  organ  invaded  frequently  en- 
dangers life,  unless  the  organ  is  freed  ot  its  colon- 
ists by  exsection  and  removal  of  the  affected  parts. 
Protection  against  this  parasite  may  be  secured  by 
avoiding  intimate  association  with  the  canine 
species,  and  by  seeing  that  such  dogs  as  do  approach 
us  are  kept  thoroughly  clean  and  well  supplied  with 
pure  drinking  water.  Echinococci  occur  most  fre- 
quently in  Iceland,  where  dogs  are  wont  to  live  in 
very#intimate  intercourse  with  men. 

The  existence  of  a  Tapeworm  can  be  positively 
asserted  only  when  parts  of  it  are  known  to  have 
been  passed.  These  parasites  may  be  avoided  by 
refusing  meat  that  is  raw  or  half -raw.  For  the  re- 
moval of  the  worm  a  time  must  be  chosen  when 
segments  have  recently  been  passed.  The  cure  must 
be  accomplished  rapidly  by  vigorous  and  persistent 
methods,  before  the  worm  has  time  to  recover  and 
form  new  adhesions.  The  latter  happens  when  the 
head  remains;  therefx)re  the  cure  is  incomplete  unless 
the  head  is  passed.     The  head  is  the  thinnest  portion. 

The  Trichina  is  a  species  of  parasite  dangerous 
to  life,  which  is  acquired  from  raw  or  half-cooked 
pork,  whether  in  the  form  of  roasts,  chops,  sausages, 
or  ham.  Impunity  against  their  ravages  attends 
only  thorough  roasting,  stewing,  and  boiling,  for 
cooking  for  a  sufficient  period  inevitably  destroys  the 
trichina. 


MOTHERHOOD. 


Menstruation  is  a  physiological  function  distinct- 
ive of  women  who  are  capable  of  motherhood.  Dis- 
turbances in  this  function  are  commonly,  but  mis- 
takenly regarded  as  the  cause  of  many  forms  of 
suffering.  Quite  the  opposite  is  true.  Diseased 
conditions  frequently  give  rise  to  disturbances  in 
menstruation,  and  therefore  it  is  generally  very  un- 
wise to  attempt  to  restore  interrupted  menstruation 
forcibly  by  means  of  drugs.  Many  temporary  in- 
dispositions, such  especially  as  catching  cold,  diges- 
tive disturbances,  great  agitations  of  mind  or  body, 
notable  increase  or  reduction  in  bodily  temperature, 
and  the  effects  of  certain  therapeutic  measures,  are 
capable,  as  well  as  numbers  of  graver  diseases,  of 
giving  rise  to  deranged  menstruation,  or  of  causing 
its  entire  cessation. 

When  severe  pains  in  the  abdomen  occur  shortly 
before  or  at  the  beginning  of  the  menstrual  period, 
constituting  the  so-called  menstrual  colic,  complete 
rest  in  the  reclining  position  is  to  be  sought,  with 
very  warm  applications  to  the  abdomen  and  warm 

330 


331 


enemata.  Excessive  menstruation  may  be  relieved 
in  a  measure  by  complete  rest  and  the  use  of  mustard 
foot  baths.  The  diet  of  those  who  menstruate  exces- 
sively should  be  very  light,  and  hot  drinks  and  con- 
diments should  be  avoided.  No  accumulation  in  the 
bowels  should  be  permitted. 

It  would  be  far  better  for  American  girls  and 
women,  if  they  followed  the  German  custom  of  rest 
and  seclusion  during  the  menstrual  week,  even 
though  that  period  may  bring  them  no  inconve- 
niences. At  this  time  the  eyesight  is  especially 
liable  to  imperfections,  and  school-girls  should,  there- 
fore, be  restrained  temporarily  from  mental  work. 

It  is  only  during  its  later  months  that  the  existence 
of  Pregnancy  can  be  ascertained  with  certainty  from 
the  movements  and  the  heartsounds  of  the  embryo. 
At  an  earlier  period  it  is  rendered  probable  by  the 
omission  of  the  periods,  by  the  occurrence  of  digest- 
ive disturbances,  such  as  nausea  and  vomiting,  by 
the  appearance  of  a  variety  of  strange  cravings,  by 
unusual  paleness,  and  by  enlargement  and  hardening 
of  the  breasts,  with  pigmentation  of  the  nipple  areas. 

Even  before  the  child  is  born  sacred  duties  toward 
her  offspring  devolve  upon  the  mother.  Inasmuch 
as  the  embryo  requires,  more  than  anything  else, 
space  in  which  to  grow  and  develop,  the  mother's 
clothing  should  be  free  from  constrictions,  especially 
at  the  waist,  but  should  fit  snugly  to  her  form  and 


332 


should  be  capable  of  affording  abundant  warmth. 
In  order  that  the  embryo  may  thrive  it  must  receive 
a  sufficient  supply  of  suitable  nourishment.  Since, 
however,  its  sustenance  is  derived  from  the  mother's 
blood  she  should  subsist  upon  a  nourishing  and 
easily  digestible  diet.  Stimulating  and  heat-forming 
foods  are  to  be  interdicted,  especially  those  which 
excite  violent  heart  action,  such  as  strong  coffee  and 
tea,  spirituous  liquors,  and  sharp  spices;  so  too  are 
indigestible  foods  and  such  as  generate  wind  and 
stimulate  micturition,  as  well  as  smoked,  hard,  and 
fat  foods.  But  milk,  eggs,  meat,  pastry,  the  plainer 
vegetables,  fruit,  and  mild  beer  are  articles  to  be 
advised.  When  necessary  to  regulate  the  action  of 
the  bowels,  this  should  be  done,  not  by  drastic  pur- 
gatives, but  by  means  of  warm  or  lukewarm  enemata. 
The  inclination  to  a  passage  should  be  immediately 
satisfied,  never  repressed. 

Those  who  expect  to  become  mothers  must  also 
avoid  blows  and  pressure  upon  the  abdomen^  jump- 
ing, running,  dancing,  horse-back  riding,  lifting  and 
carrying  heavy  weights,  bending  far  over,  crying,, 
loud  laughing,  riding  in  an  uncomfortable  position, 
and  all  other  considerable  exertions.  All  strong 
emotions,  anger,  hate,  grief,  fear,  envy,  jealousy, 
exercise  an  inomeasurably  disastrous  influence  over 
both  mother  and  embryo,  while  quietude  of  mind, 
good  spirits;  and  self-satisf actiori  are  of  proportionate 


000 


benefit.  The  physical  well-being  of  the  mother  is 
essentially  promoted  by  daily  but  moderate  exercise, 
both  out  of  doors  and  in  a  well  ventilated  house,  as 
well  as  by  a  sufficient  amount  of  rest  and  sleep.  The 
mother  must  not  deceive  herself  with  the  idea  that 
constant  rest  and  inactivity  are  beneficial  to  her  ex- 
pected offspring.  It  is  far  better  for  a  woman  to 
perform  light  household  duties,  and  to  go  out  fre- 
quently. Long  and  frequent  sleeping  are  also 
objectionable.  Baths  are  indispensable  to  everyone, 
but  especially  to  a  pregnant  woman. 

The  Lying-in  room  should  be  spacious,  high,  and 
free  from  dampness,  and  its  atmosphere  should  be 
pure  and  comfortably  warm.  All  necessary  articles 
should  be  made  ready  beforehand. 

The  calling  of  the  physician  ought  never  to  be  left 
till  the  last  moment.  .It  is  urgently  to  be  advised  that 
the  patient  should  cause  herseK  to  be  examined 
by  her  physician  at  intervals  during  the  preceding 
weeks.  Upon  such  occasions  the  most  scrupulous 
care  is  to  be  expected  of  the  physician  in  the  disin- 
fection of  his  hands. 

Just  as  the  general  muscular  system  attains  in 
different  individuals  a  varying  degree  of  develop- 
ment, so  the  womb,  which  is  in  reality  only  a  muscle, 
shows  different  degrees  of  resistance  in  different 
women.  There  are  healthy,  strong  races,  such  as 
the    Montenegrins,   the  Albanese,   the  Kafirs,   and 


334 


others,  whose  women  are  accustomed  to  resume 
their  wonted  occupations  at  the  very  latest  upon  the 
second  or  third  day  after  dehvery,  a  procedure  which 
our  city-bred  ladies  would  be  apt  to  find  fatal.  The 
power  of  resistance  and  the  contractile  energy  pos- 
sessed by  the  womb  in  many  of  our  women  is  so 
feeble  that  the  bloodvessels  do  not  close  properly  after 
delivery,  and  their  gaping  exposes  the  patient  to  fatal 
hemorrhage.  With  such  women  parturition  means 
an  overexertion,  and  at  its  conclusion  the  contractile 
power  of  the  womb  is  found  to  be  exhausted,  so  that 
blood  flows  forth  freely  and  in  great  abundance, 
while  the  germs  of  putrefaction  and  disease  find 
ready  entrance. 

After  the  accomplishment  of  delivery  the  only 
attention  required  at  first  by  the  mother  is  that  of 
ascertaining  every  few  minutes  that  the  discharge  is 
not  excessive  and  that  the  patient  has  sufiicient  cov- 
ering. The  remainder  of  the  time  under  ordinary 
circumstances  may  be  devoted  to  the  child.  When 
its  crying  demonstrates  that  the  infant  is  not  want- 
ing in  vitality,  it  may  be  at  once  washed,  dried,  and 
dressed.  If  it  be  feeble,  and  particularly  if  its  respir- 
ation is  shallow,  it  should  be  stimulated  until  it  cries 
lustily.  This  may  be  done  by  plunging  it  alternately 
into  tubs  previously  filled  with  warm  and  with  cold 
water,  by  slapping  it  vigorously  from  time  to  time 
upon  the  buttocks,  or,  if  other  means  fail,  by  pushing 


335 


a  quill  deep  into  its  nostrils  as  a  means  of  stimu- 
lating voluntary  respiration.  The  simplest  method  of 
performing  artificial  respiration  is  that  of  inspiring 
and  expiring  air  by  contact  of  the  nurse's  mouth  with 
that  of  the  child.  Another  method,  often  found  very 
efficient,  is  to  bring  the  child's  hands  together  as  high 
as  possible  above  its  head  by  grasping  them  at  the 
elbows,  and  to  return  them  again  through  a  full  arc 
to  their  natural  position  beside  the  thighs,  this  move- 
ment being  repeated  about  sixteen  times  a  minute 
until  natural  respiration  begins. 

Some  fifteen  minutes  or  more  after  the  birth  of 
the  child  the  principal  attention  may  be  turned  again 
to  the  mother.  The  afterbirth  should  now  be  removed 
and  from  time  to  time  a  tablespoonful  of  some  re- 
freshing and  strengthening  fluid  should  be  given 
the  mother,  attention  still  being  paid  at  increasing 
intervals  to  the  possibility  of  hemorrhage.  Should 
bleeding  become  abundant,  the  drug  prescribed  by 
the  physician  and  kept  at  hand  for  that  purpose, 
should  be  at  once  administered.  One  or  both  hands 
may  then  be  laid  firmly  flat  upon  the  lower  portion 
of  the  womb,  stopping  the  bleeding  in  just  the  same 
way  as  when  pressure  is  produced  by  a  hand  upon  a 
wounded  arm.  The  attention  which  it  is  necessary 
to  pay  to  the  question  of  possible  hemorrhage  in  a 
parturient  woman  is  all  the  more  important  inas- 
much as  she  herself  is  nearly  stupefied  as  a  result 


336 


of  her  exhaustion  and  is  not  likely  to  perceive  even 
copious  bleeding.  Hemorrhage  is  most  apt  to  occur 
during  the  first  hour  after  delivery,  and  this  is  the 
time  when  the  doctor  should  not  fail  to  be  at  hand 
to  render  assistance. 

Some  half  hour  or  more  after  the  removal  of 
the  afterbirth,  provided  no  severe  bleeding  has  oc- 
curred, the  bedlinen  should  be  changed,  the  region 
of  the  external  organs  being  first  cleansed,  but  these 
organs  themselves  not  until  the  physician  permits. 
The  linen  used  should  be  new  and  perfectly  clean, 
and  it  should  be  warmed  before  use,  for  the  patient 
is  almost  sure  to  feel  cold  and  require  special  atten- 
tion to  restore  her  bodily  warmth.  The  ventilation 
of  the  room  should  not,  however,  be  allowed  to  suf- 
fer for  the  sake  of  obtaining  warmth.  Ventilation 
should  be  accomplished,  if  possible,  through  an  ad- 
joining apartment. 

For  protection  against  the  invasion  of  the  germs 
of  decomposition,  and  for  the  better  removal  of  se- 
cretions which  interfere  with  cleanliness,  an  ample 
quantity  of  loose  iodoform  gauze,  oakum,  or  marine 
lint  should  be  placed  between  the  thighs  several 
times  a  day  so  long  as  the  patient  remains  in  bed. 
The  soiled  material  must  be  burned  at  once  on  re- 
moval. 

The  lying-in  period  requires  complete  rest,  the 
utmost  cleanliness,  constant  or  very  frequent  change 


33? 


of  air,  properly  regulated  diet,  attention  to  tlie  quan- 
tity of  the  perspiration  and  to  the  secretions.  When 
possible,  the  child  should  be  nursed  by  the  mother 
herself.  All  mental  disturbances  are  to  be  avoided, 
and  all  needless  callers  excluded.  Sleep  never 
must  be  disturbed  without  the  most  urgent  necessity. 
The  diet  must  be  simple  and  of  easy  digestion.  If 
the  patient  has  no  passage  up  to  the  second  or  third 
day,  a  dose  of  castor-oil  or  an  enema  of  warm  water 
should  be  given.  A  warm  bedpan  must  invariably 
be  employed.  Strict  cleanliness  is  to  be  observed  in 
regard  to  the  person  and  clothing  of  the  patient,  quite 
as  much  as  in  the  room  and  bed. 

Sore  Nipples  are  a  not  infrequent  malady  of  the 
lying-in  period,  and  of  the  succeeding  months  of 
lactation.  By  way  of  protection  against  this  affec- 
tion we  may  recommend  during  pregnancy  frequent 
washing  of  the  nipple  with  medicated  waters  and 
alcoholic  fluids,  and  free  access  of  air ;  and  during 
nursing  the  greatest  cleanliness  and  protection  of 
the  nipple  against  pressure.  The  use  of  artificial 
nipples  during  the  first  four  or  five  weeks  is  a  good 
means  of  preventing  the  nipples  from  becoming  sore. 
If  even  the  slightest  pain  occurs  while  nursing, 
resort  should  be  had  at  once  to  the  nippleshield,  so 
perhaps  preventing  a  sore. 

The  best  preventives  of  sore  nipple  are  painting 
the  dry,  clean,  nipple  with  collodion^  nitrate  of  silver, 


338 


limewater,  boracic  acid,  dilute  spirits  of  turpentine, 
or  almond  oil.  When  the  inflammation  is  severe, 
the  sick  child  should  not  be  allowed  to  nurse  the 
diseased  breast,  but  the  milk  should  be  removed  by 
other  and  milder  means.  The  constant  drawing  out 
of  a  sunken  nipple  during  pregnancy,  with  the  re- 
sulting anticipation  of  the  milk  secretion,  seems  cap- 
able of  causing  the  death  of  the  embryo.  Painting 
an  area  around  the  nipple  with  collodion  is  recom- 
mended as  a  means  of  developing  the  nipple  and 
drawing  it  out. 

Sore  Eyes  in  new-born  children  commonly  result 
from  discharges  or  other  foreign  matters  which  have 
gotten  beneath  the  eyelids  at  the  time  of  birth. 
Cleanliness  is  in  this  instance,  as  in  so  many  others, 
the  great  preventative  and  curative.  The  eyes 
should  be  carefully  washed  out,  as  often  as  the  child 
is  bathed,  with  warm  water  in  which  a  pinch  of 
boracic  acid  has  been  dissolved.  No  violence  should 
be  used,  and  all  light  should  be  excluded  by  darken- 
ing the  room.  If  these  measures  do  not  promptly 
allay  the  inflammation,  a  physician's  advice  should 
be  sought,  as  a  precaution  against  possible  blindness. 


INDEX. 


Ability,  Variation  in  Individual,  lOO. 

Abscess,  216. 

Accidents,  187. 

Acid,  Carbolic,  150,  245  ;  Prussic, 

229. 
Acids,   Mineral,   222,   226  ;    Vege- 
table, 226. 
Aconite,  Poisoning  by,  230. 
Adulteration  of  Food,  37;  of  Brandy, 

39  ;  of  Butter,  37  ;  of  Coffee,  38  ; 

of  Horseradish,  40  ;  of  Jellies,  40; 

of  Lard,  38;  of  Milk,  37;  of  Tea, 

39  ;  of  Wines,  39. 
Afterbirth,  335. 
Airshaft,  163. 

Albuminous  Substances,  23. 
Alcohol,  39,  41,  79,  208,  210,  246, 

266,  268,  295  ;  Poisoning  by,  231. 
Alkalies,  226. 
Alpine  Club,  98. 
Anaemia,  loo,  259,  293. 
Antimony,  Poisoning  by,  224. 
Antiseptics,  245,  275. 
Apoplexy,  127,  262,  264. 
Armour,  S.  G.,  M.  D.,  295. 
Arsenic,    135,   304 ;   Poisoning  by, 

223. 
Asthma,  286. 

Babcock,  M.  Z?.,  log. 

Bathing,  63,  114,  126,  173,  256,  258. 

Bedbugs,  239,  328. 

Bed  of  the  Patient,  175,  176  ;  Dis- 
infection of,  152. 

Bedroom,  55,  80,  140,  163, 203, 257, 
273,  281,  283. 

Bedsores,  173. 

Bed,  Wetting  the,  325. 

Beer,  36. 

Belladonna,  Poisoning  by,  229, 

BUe,  53,  68. 


Biliousness,  317. 

Bites  of  Bedbugs,  239  ;  of  Dogs, 
235  ;  of  Mosquitoes,  239 ;  of 
Skunks,  236;  01  Snakes,  236. 

Bladder,  Spasm  of  the,  324. 

Bleeding,  213,  335. 

Blood,  59,  205  ;  Purification  of,  59. 

Brain,  77,  177,  298. 

Bread,  34. 

Breath,  Disagreeably  224,  289. 

Brown-Sequard,  M.  Z>,,  277. 

Brunton,  Lauder,  M.D.^  2.^2., 

Burns,  217. 

Butter,  37. 


Caisson  Disease,  299. 
Calisthenics,  58,  97,  118. 
Carbo-hydrates,  23. 
Carbolic  Acid,  150,  245. 
Carbonic  Acid  Gas,  54,  55,  62,  198, 

233. 
Carbonic  Oxide,  55,  135,  198,  233. 
Carpets,  161,  282. 
Cellar,  145,  198. 
Cereals,  33. 
Cesspools,    244 ;    Disinfection    of, 

154. 
Chamber- vessel,  175. 
Cheese,  32. 
Chilblains,  327. 
Childhood,  Hygiene  of,  115. 
Chlorosis,  259. 
Cholera,  242,  246,  305. 
Cholera  Infantum,  315. 
Cigarettes,  44. 

Circulation,  10,  96,  298,  300,  322. 
Circulatory  Organs,  Hygiene  of  the, 

Clergymen,  183,  279. 
Climate,  65,  164,  274, 

339 


uo 


Clothing,  63,  65,  117,  120, 126, 280, 
283,  331  ;  Disinfection  of,  152. 

Cocoa,  45. 

Coffee,  38,  45,  227,  228,  232,  260, 
266,  268. 

Colchicwm,  Poisoning  by,  230. 

Cold,  64,  138,  210,  245,  264. 

Colic,  Lead,  225. 

Collar,  67. 

Coney  Island,  312. 

Constipation,  315. 

Consumption,  81,  100,  271  ;  Pul- 
monary, 274. 

Contagious  Diseases,  241,  242. 

Convulsions,  256. 

Copper,  135  ;  Poisoning  by,  223. 

Corns,  327. 

Cough,  272. 

Corset,  58,  67. 

Cow's  Milk,  281,  284,  314. 

Cramps  when  Bathing,  194. 

Cravat,  67. 

Cretinism,  177. 

Croup,  285. 

Cuts,  214. 

Dancing,  96. 

Death,  Proof  of,  189. 

Decomposition,  157,  190,  215. 

Dejections,  152. 

Diarrhoea,  308,  311. 

Diet,  14,  267. 

Digestion,  13,  95,  263. 

Digestive  Fluids,  13. 

Digestive  Tract,   Diseases  of  the, 

290. 
Digestive  Organs,  Hygiene  of  the, 

47. 

Digitalis,  Poisoning  by,  230. 

Diphtheria,  51,  285. 

Disinfection,    146,    150,    243,    246, 

250  ;  ot  Beds  and  Clothing,  152  ; 

of  Cesspools,  154  ;   of  Furniture, 

153. 
Dislocations,  216. 
Divergencies  of  Taste,  18. 
Dogs,  Mad,  235. 
Drafts,  64,  138,  313. 
Drainage,  120,  147. 
Draper,  William  H.,  M.  /?.,  268. 


Dress,  61,  117. 
Dropsy,  260. 
Drowning,  192, 
Drugs  and  Druggists,  179. 
Dust,  56,  244,  272,  282. 
Dwelling,  Hygiene  of  the,  138- 
Dwellings,  American,  160. 
Dysentery,  308. 
Dyspepsia,  100,  258,  290. 

Ear,  Hygiene  of  the,  87. 

Echinoi  occus,  328. 

*Eczema,  63,  326. 

Eggs,  3). 

Egotism,  128. 

Electric  Light,  162. 

Embryo,  332. 

Emergencies,  How  to  Give  Aid  in, 

187. 
Emetics,  221,  226. 
Emotions,  129,  332, 
Epidemics,  246. 
Epilepsy,  254. 
Ergot,  Poisoning  by,  230. 
Eruptions  on  the  Skin,  326. 
Erysipelas,  215.    ^ 
Evaporation,  62,  65,  155. 
Excretions,  143,  146,  152,  246,  309. 
Exercise,  94,  118,  279,  296. 
Eye,  82,  177. 

Eyes,  Sore,  in  Infants,  338. 
Eye,  Hygiene  of  the,  83. 
Eyeglasses,  85. 

Fainting,  188. 

Family  Physician,  184. 

Fatigue,  92,  94,  203. 

Fatty  Substances,  23. 

Feet,  70;  Perspiration  of  the,  327. 

Fermentation,  22,  245,  294. 

Filtering,  26,  307. 

Fishbones,  211. 

Flatulence,  320. 

Flies,  243. 

Flint,  Austin,  M.  Z>.,  278. 

Flour,  33,  37,  310. 

Food,  10,  II,  126,  244,  332;  Adul- 
teration of,  37  ;  Cost  of,  17  ;  Ex- 
cess of,  21,  299,  318;  Preparation 
of,  22,  244  i  Selection  of,  16. 


341 


Food  for  the  Sick,  172. 
Fractures,  216. 
Freezing,  245,  264. 
Frostbites,  327. 
Fruits,  17,  22. 
Fumigation,  55,  141,  153. 
Furniture,  Disinfection  of,  153. 


Gallstones,  319. 

Gargling,  51. 

Garter,  70. 

Gas,  Carbonic  Acid,  54,  55,  62,  198, 
233;  Chlorine,  232;  Hydrochloric, 
232;  Illuminating,  146,  198,  201, 
233;  Nitric,  232;  Sewer,  56,  149, 
198,  246;  Sulphuric  Acid,  232. 

Gaslight,  82,  86. 

Gases,  Acid,  232. 

Glanders,  240. 

Gout,  100,  267. 

Graveyards,  157. 

Ground,  158. 

Gymnastics,  58,  97,  118,  255,  270, 
320. 


Hau*,  63. 

Hall,  Marshall,  M.  Z>.,  192. 

Hardening,  115,  125. 

Hat,  66. 

Hay  Fever,  288. 

Head,  66. 

Health  and  Morals,  127,  253. 

Heart  Diseases,  100,  262. 

Heartburn,  290. 

Heat,  75,  205,  245,  264,  267. 

Heating  Apparatus,  156. 

Hemlock,  Poisoning  by,  230. 

Hemorrhage,  211,  265  ;  from  the 
Lungs,  213  ;  from  the  Nose,  212; 
from  the  Womb,  335. 

Hemorrhoids,  321. 

Hernia,  219,  320. 

Houses,  Situation  of,  156  ;  Tene- 
ment, 162. 

Hydrogen,  Sulphxu-etted,  201. 

Hydrophobia,  235. 

Hyoscyamus,  Poisoning  by,  229c 

Hysteria,  253. 


Ice,  27,  244. 

Illuminating  Gas,  149,  198, 201,  233. 
Impediments  to  Nutrition,  41  o 
Incarcerated  Hernia,  320. 
Indigestion,  100,  258,  290. 
Infancy,  Hygiene  of,  103,  256,  280, 

283,  310. 
Injuries,  213,  233. 
Insects,  239,  243. 
Insomnia,  79,  256. 
Insurance,  129,  130. 
Intemperance,  131,  203,  208,  2!0. 
Intermittent  Fever,  81,  247. 
Iron,  7. 

Jacobi,  Abr.,  M.D.,  106,  107,  109, 

313- 
Johnston,  W.  W.,  M.  Z>.,  316. 

Jellies,  40. 

Kidneys,  61. 
Kindergarten,  117. 
Kissing,  51,  284,  286. 
Kitchen,  164. 
Koch,  M.  Z>.,  150. 

Lard,  38. 

Lead,  134;  Poisoning  by,  225. 

Lead  Colic,  225. 

Life  Insurance,  129,  130. 

Light,  74,  82,  176;  Electric,  162. 

Lightning,  202. 

Linoleum,  161. 

Liver,  60. 

Lungs,  60. 

Lying  in  Room,  333. 

Malaria;  75,  81,  242,  247,  270. 

Marriage,  131,  253. 

Marshes,  159. 

Marsh  Gas,  56. 

Massage,  95,  225,  270,  319. 

Mastication,  295. 

Meals,  Number  of,  16. 

Mealtime,  What  to  do  before  and 

after,  15. 
Meat,   II,  28,  29;  Preparation  of, 

31;  Quality  of,  31. 
Medication,  180. 
Meigs,  Arthur,  M.  Z>.,  109. 


342 


Menstruation,  113,  I2T,  302,  330. 

Mercury,  135;  Poisoning  by,  224. 

Miasmatic  Diseases,  241,  242. 

Milk,  27,  37,  104,  244,  280;  Pre- 
paration of  for  Infant  Feeding,  1 1 1 . 

Milk  Sugar,  109. 

Miscarriage,  303. 

Morals,  127,  253. 

Mosquitoes,  178,  239. 

Motherhood,  330. 

Mountain  Climbing,  97,  264,  296, 
322. 

Mouth,  47,  51;  Bad  Smelling,  224. 

Muscles,  Hygiene  of  the,  92. 

Nap,  16. 

Neck,  67. 

Nervous  System,  Diseases  of  the, 

253- 
Nervous  System,  Hygiene  of  the,  77. 
Nipples,  Sore,  337. 
Nitrate  of  Silver,  Poisoning  by,  224. 
Nosebleed,  212. 

Nostrils,  Hygiene  of  the,  88,  274. 
Nursing,  104,  106,  170,  179,  247. 
Nutrition,  Diseases  of  Altered,  259. 

Obesity,  61,  100,  261,  287,  318. 
Occupation,  136,  246,  254,  270. 
Odor,  Disagreeable,  from  the  Feet, 

327  ;  from  the  Mouth,  224,  289  ; 

from  the  Nose,  289. 
Old  Age,  Hygiene  of,  123. 
Opium,  Poisoning  by,  228. 
Overexertion,  79,  93,  124. 
Overfeeding,  21,  106,  278,  294. 
Overheating,  82,  203,  312. 
Oxide,  Carbonic,  55,  135,  198,  233. 
Oxygen,  62,  74,  82,  92,  233,  277. 

Pains,  Abdominal,  308,  320,  330. 
Parasites,  41,  328. 
Parasol,  67. 
Parturition,  303. 
Pepsin,  290. 

Perspiration,  65,  273,  280,  318,  327. 
Pestilence,  246. 
Pettenkofer,  M.D.^  143. 
Phosphorus,  135;  Poisoning  by,  223, 
226. 


Physician,  The  Family,  182,  184. 

Pillow,  82. 

Pipes,  147,  225. 

Plague,  242,  246. 

Poisoning  by  Aconite,  230 ;  Alec 
hoi,  231  ;  Arsenic,  223  ;  Bella- 
donna, 229;  Carbonic  Acid,  198; 
Carbonic  Oxide,  198;  Colchicum, 
230;  Copper,  223;  Digitalis,  230; 
Ergot,  230;  Glanders,  240;  Hem- 
lock, 230;  Hyoscyamus,  229;  11- 
luminating  Gas,  198;  Insects,  239; 
Lead,  225 ;  Mad  Dogs,  235 ;  Mer- 
cury, 224;  Metals,  222;  Mineral 
Acids,  222;  Nitrate  of  Silver,  224; 
Opium,  228;  Phosphorus,  223, 
226 ;  Prussic  Acid,  229 ;  Scor- 
pions, 239 ;  Sewer  Gas,  198 ; 
Skunks,  236;  Snakes,  236;  Stra- 
monium, 229  ;  Strychnia,  230  ; 
Tarantulas,  239;  Toadstools,  230, 

Potassium  Cyanate,  Poisoning  by, 
229. 

Pregnancy,  302,331. 

Prevention  of  Disease,  9. 

Priesnitz  Dressing,  174. 

Prudden,  T.  Mitchell,  M,  Z>.,  27, 
244. 

Ptomaines,  245. 

Purification  of  the  Blood,  59. 

Respiration,  69,  204,  262,  230;  Ar- 
tificial, 191,  195,  198,  200,  202, 
207,  228,  230,  334. 

Respirator,  180. 

Respiratory  Organs,  Hygiene  of  the, 

53- 
Respiratory  Tract,  Diseases  of  the, 

272. 
Rest,  59,  263. 
Revival,  192. 
Rheumatism,  100,  269. 
Richardson,    Benj.  Ward,    M.  Z>,, 

40. 
Ripley,  John  H.,  M.  Z).,  313. 
Roof,  157. 

Roosa,  D.  B.  St.  John,  M.  Z?.,  119. 
Rupture,  219. 


343 


Saint  Vitus's  Dance,  254. 

Salivation,  43,  50,  224,  295. 

Salts,  25. 

Salt,  117,  220,  224. 

Scabies,  328. 

School,  78,  84,  273. 

Sv-hool  Children,   Hygiene  of,  117, 

331- 
School  Desks,  118. 
School  Teachers,  183. 
Scorpions,  239. 
Seasickness,  297. 
Selection  of  Food,  16. 
Selection  in  Marriage,  131. 
Sewage,  144,  244. 
Sewerage,  143,  147,  244,  248. 
Sewer  Gas,  56,  149,  198,  246,  249. 
Sick,  Care  otthe,  168;  Noises  about, 

178;  Visitors  to  the,  178,  182,  183. 
Sick-room,  171,  176, 
Skin,   Diseases  of  the,  326. 
Skin,  Hygiene  of  the,  61. 
Sleep,    55,  59,  79,   116,    118,    177, 

203,  208,  226,  256,  282. 
Smith,  Andrew  H.,  M.  D.,  299. 
Smith,  T.  Lewis,  M.  D.,  2,12. 
Smoking,  44. 
Soil,  158,  243. 
Spasm  of  the  Bladder,  324  ;  of  the 

Stomach,  296. 
Spine,  83,  119. 

Spittoons,  Disinfection  of,  175. 
Sputum,  282. 
Stomach,  51,  303  ;   Spasm  of  the, 

296;  Ulcer  of  the,  297. 
Stomach  Pump,  232. 
Stoves,  82,  156. 

Stramonium,  Poisoning  by,  229. 
Strychnia,  Poisonmg  by,  230. 
Sublimate,  Corrosive,  151,  245. 
Sucking  Bag,  104. 
SufiFocation,  198,  233. 
Sulphuretted  Hydrogen,  201. 
Summer  Complaint,  310. 
Sunshine,  176, 
Sunstroke,  203,  312. 
Suspenders,  67. 
Sutures,  214. 


Swamps,  159,  248. 
Sylvester,  M.  D.,  194. 


Tapeworm,  329. 
Tarantula,  239. 
Taste,   Hygiene  of  the,  89  ;  Diver. 

gencies  of,  18. 
Tea,  39,  45,  227,  260,  266,  268. 
Teeth,  295,  313;  Broken,  89;  Caries 

of,  49;  First,  113;  Ulcerated,  217. 
Tenement-houses,  162. 
Throat,  49,  274  ;  Foreign  Bodies  in 

the,  211. 
Tissue  Metamorphosis,  10. 
Tobacco,  43,  50. 
Tobacco-smoke,  56. 
Toys,  117. 
Trance,  189. 

Traps  in  the  Waste  Pipe,  147. 
Traube,  M.D.,  276. 
Trichina,  329, 
Trudeau,  M.D.,  z'jS. 
Trusses,  220. 

Tuberculosis,  271  ;  Pulmonary,  274. 
Type,  84. 
Typhoid  Fever,  242,  244,  246,  249. 


Uric  Acid,  267. 

Urinary  Tract,  Diseases  of  the,  324. 

Urine,  61,  238,  324. 


Variations  in  Individual  Ability,  lOO. 
Vegetables,  17,  22;  Leguminous,  18, 

35- 
Ventilation,  54,   80,   138,   141,  159, 

176,  208,  225,  246. 
Visitors  to  the  Sick,  178,  182,  183. 
Voice,  Hygiene  of  the,  90. 
Vomiting,  221,  227,  228,  301,  313, 

320. 


WaUs,  156,  283. 

Waring,  George,  E.,  Jr.,  147. 

Washing,  63. 


344 


Water,  2$,  6l,  209,  232,  243,  244, 

249,  263,  326. 
Weaning,  113,  315. 
Welch,  William  H.,  M,  D.,  243. 
Wells,  159,  198- 
Wet  Nurse,  106,  280. 
Wetting  the  Bed,  325. 


Windows,  162. 

Wine,  15,  36,  39. 

Workshop,  Hygiene  of  the,  133, 220. 

Wounds,  215,  222,  233. 

Yellow  Fever,  81,  246,  251. 
Youth,  Hygiene  of,  121. 


SCOTT'S 
EMULSION 


OF 


PURE  COD  LIVER  OIL, 

AND 

Hypophosphites  of  Lime  and  Soda. 

The  greatest  FOOD  MEDICINE  the  science 
of  pharmacy  has  ever  produced. 

The  proper  and  perfect  emulsification  and  partial 
digestion  of  the  Cod  Liver  Oil — thoroughly  incor- 
porated with  the  Hypophosphites  and  Glycerine, 
as  prepared  in  Scott's  Emulsion — seems  to  give 
it  a  potency  over  disease,  in  checking  waste,  and 
building  up  the  body,  that  is  most  astonishing  to 
physicians. 

For  SICKLY,  DELICATE  CHILDREN, 
CONSUMPTION,  ANEMIA,  and  every  form 
of  wasting ,  the  physicians  finds  it  a  remedial  agent 
of  most  remarkable  value. 

It  has  the  great  advantage  over  the  plain  Cod 

Liver  Oil  or  other  Emulsions,  in  being  acceptable 

to    almost    all    patients    without    disturbing   the 

stomach,  and  it  does  not  separate  nor  grow  rancid 

like  other  preparations. 

SCOTT  &  BOWNE,  New  York. 

(ix; 


.O.^LATEST    AWARDS    TO    THE     MANUFACTURER.^oo. 

SILVER    MEDAL.  BRONZE   MEDAL. 


MELBOURNE,  AUS.,  i 


HAMBURG,  1889. 


HOFF'S  MALT  EXTRACT, 

Manufactured  by  Leopold  Hoff,  Hamburg, 

Recognized  by  physicians  for  more  than  twenty- 
three  years  as  the 

Standard  Nutritive  Tonic 

FOR 

Convalescents,  Nursing    Mothers,  Sick 
Children,  and  in  all  Wasting 
Diseases. 

Superior  to  any  other  preparation  as  a  safe  and 
pleasant  appetizer  and  invigorant,  which  can  be 
used  by  the  most  delicate  invalid  with  the  best 
effect. 


itfiM^mr... 

?"'n;;;;Si;;;;:;;;:;!i!::;;:ji;;;:?;-- 

.';""' i»..,iiii.."i..«.  I ■■"  ;■  ■  =a 

^iiFACTDSSATHAM^ji 


CAUTION. 

Beware  of  a  "so-called"  Malt  Extract  put  up 
in  the  squatty  bottle,  with  the  names  "Johann 
Hoffand  •' Moritz  Eisner"  on  neck.  The  origi- 
nal and  genuine  imported  article  can  only  be  ob- 
tained in  the  United  States  in  bottles  as  per  cut, 
and  bearing  our  name  on  label. 


Always  specify  TARRANT'S   when  ordering- 
HOFF'S  MAL.T  EXTRACT. 

Tarrant  &  Co.,  Sole  Agenis  &  Importers, 

ESTABLISHED  1834^ 
(x) 


EFFERVESCENT 


SELTZER  APERIENT 

Approved  and  prescribed  by  the  leading  American  practitioners 
for  more  than  forty  years. 

THE  BEST  KNOWN  REMEDY  FOR 

Constipation,  j^^^  indigestion, 

SiGl(  Headaclie,  ^^^^^  Torpid  Liver, 

Biliousness,  l^s^P  ^^^  Sickness, 

Heartburn,  ^^^^  Sour  Stomach, 

And  all  distressing  symptoms  arising  from  imperfect  digestion  or 

disordered  stomach. 


Emphatically  a  Household  Remedy 

Its  pleasant  taste  renders  it  particularly  adapted  for  administration  to 
children  or  invalids,  and  in  all  cases  where  the  old  fashioned  aperients 
cannot  be  tolerated. 

Its  efficacy,  ease  of  administration,  and  the  safety  with  which  it  can 
be  given  to  patients  of  all  ages  make 

^airraLnl's  gelleer  Aperient 

A  remedy  "that  should  be  found  in  every  family  medicine  chest. 

TARRANT  &  CO., 

NEW    YORK. 

ESTABLISHED     1834. 


DR.    JULIAN     FEHR'S 

"  COMPOUND     TALCUM  ' 

THE 

"HYGIENIC    DERMAL    POWDER" 

FOR 

INFANTS   AND   ADULTS. 


Useful  as  a 


GENERAL    SPRINKLING 
POWDER 

And  in  all 

AFFECTIONS 

OF  THE  SKIN, 

On  account  of  its 

Sanitary,   Prophylactic 

and  Therapeutic 

Properties. 

Sold  by  the  Drug  trade  generally. 

Per  box,  plain,  -   -   -   25c. 
perfumed,  -   -    50c. 

The  Manufacturer  : 


fi 


JULIUS  FEHR,  M.D. 

Bnclent  ipbarmacist, 


This  preparation  is  only  advertised 
in  Medical  and  Pharmaceutical  prints. 


Uii) 


